Provider Demographics
NPI:1003354689
Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Other - Org Name:
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:405-509-7370
Mailing Address - Fax:405-509-7373
Practice Address - Street 1:1800 RENAISSANCE BLVD
Practice Address - Street 2:SECOND FLOOR TOWER, SUITE 210
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3023
Practice Address - Country:US
Practice Address - Phone:405-509-7370
Practice Address - Fax:405-509-7373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4343207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty