Provider Demographics
NPI:1003094129
Name:JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:HARMON MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-379-5500
Mailing Address - Street 1:400 E CHESTNUT ST
Mailing Address - Street 2:P.O. BOX 791
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2030
Mailing Address - Country:US
Mailing Address - Phone:580-688-3363
Mailing Address - Fax:580-688-9730
Practice Address - Street 1:400 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2030
Practice Address - Country:US
Practice Address - Phone:580-688-3363
Practice Address - Fax:580-688-9730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
37Z338OtherMEDICARE ID