Provider Demographics
NPI:1003318692
Name:STILLWATER MEDICAL CENTER AUTHORITY
Entity Type:Organization
Organization Name:STILLWATER MEDICAL CENTER AUTHORITY
Other - Org Name:PERRY MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:ADRIENNE
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-742-5230
Mailing Address - Street 1:PO BOX 23281
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4483
Mailing Address - Country:US
Mailing Address - Phone:405-533-6057
Mailing Address - Fax:405-742-5736
Practice Address - Street 1:501 N 14TH ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OK
Practice Address - Zip Code:73077-5021
Practice Address - Country:US
Practice Address - Phone:580-336-3541
Practice Address - Fax:580-336-7209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STILLWATER MEDICAL CENTER AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-28
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital