Provider Demographics
NPI:1013195684
Name:BEAVER COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAVER COUNTY MEMORIAL HOSPITAL
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-625-4551
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-0640
Mailing Address - Country:US
Mailing Address - Phone:580-625-3646
Mailing Address - Fax:580-625-3844
Practice Address - Street 1:212 EAST 8TH STREET
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932
Practice Address - Country:US
Practice Address - Phone:580-625-3646
Practice Address - Fax:580-625-3844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK693029332B00000X, 332BP3500X, 332BX2000X, 3336C0003X, 3336I0012X, 3336L0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK90003921830Medicaid
OK100700760CMedicaid
OK500522162Medicare PIN
OK90003921830Medicaid