Provider Demographics
NPI:1043323447
Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC.
Other - Org Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-654-1050
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015-0097
Mailing Address - Country:US
Mailing Address - Phone:580-654-1050
Mailing Address - Fax:580-654-2111
Practice Address - Street 1:102 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1050
Practice Address - Fax:580-654-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102146L00000X
207P00000X, 2085R0202X, 363LF0000X
OK2215282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Single Specialty
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699690CMedicaid
OK100699690AMedicaid
OK242316105Medicare PIN
OK200522010Medicare PIN
OK242316103Medicare PIN
OK100699690AMedicaid
OK24C728901Medicare PIN
OKG45025Medicare UPIN
OK371334Medicare Oscar/Certification
OK246722501Medicare PIN