Provider Demographics
NPI:1801299607
Name:SAYRE MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:SAYRE MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:BATES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:580-298-5541
Mailing Address - Street 1:911 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1206
Mailing Address - Country:US
Mailing Address - Phone:580-928-5541
Mailing Address - Fax:580-928-3523
Practice Address - Street 1:1002 NE HIGHWAY 66
Practice Address - Street 2:SUITE 1
Practice Address - City:SAYRE
Practice Address - State:OK
Practice Address - Zip Code:73662-9312
Practice Address - Country:US
Practice Address - Phone:580-928-9914
Practice Address - Fax:580-928-9913
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAYRE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-07
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2207207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700160JMedicaid