Provider Demographics
NPI:1770711061
Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-338-3113
Mailing Address - Street 1:520 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4438
Mailing Address - Country:US
Mailing Address - Phone:580-338-6515
Mailing Address - Fax:580-468-3442
Practice Address - Street 1:1753 N ROOSEVELT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2729
Practice Address - Country:US
Practice Address - Phone:580-468-3035
Practice Address - Fax:580-468-3037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699630IMedicaid
OK100699630IMedicaid