MEDICARE: GRADY MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578592788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRADY MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	2220 W IOWA AVE
Second Line	:
City	:	CHICKASHA
State	:	OK
Zip	:	73018-2738
Country	:	US
Telephone Number	:	405-224-2300
Fax Number	:	405-779-2413

Provider Business Practice Location Address
First Line	:	113 SOUTH RUSH AVE
Second Line	:
City	:	RUSH SPRINGS
State	:	OK
Zip	:	73082-0277
Country	:	US
Telephone Number	:	580-476-2527
Fax Number	:	580-476-3707

Authorized Official
Title or Position	:	CEO
Name	:	STEVE PAUTLER
Credential	:
Telephone Number	:	405-779-2150

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	01/06/2026

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Directions to “GRADY MEMORIAL HOSPITAL ” Practice Location

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