MEDICARE: JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC.

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center	2190	OK

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	:	1730223090
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE PHILLIPS MEMORIAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	3500 STATE ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2932
Country	:	US
Telephone Number	:	918-333-7200
Fax Number	:	918-331-1447

Provider Business Practice Location Address
First Line	:	3500 STATE ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-2932
Country	:	US
Telephone Number	:	918-333-7200
Fax Number	:	918-331-1447

Authorized Official
Title or Position	:	CFO
Name	:	MIKE A. MOORE
Credential	:
Telephone Number	:	918-331-1644

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	05/21/2008

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