Provider Demographics
NPI:1043498108
Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:PERRY MEMORIAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-336-3541
Mailing Address - Street 1:501 N 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OK
Mailing Address - Zip Code:73077-5021
Mailing Address - Country:US
Mailing Address - Phone:580-336-3541
Mailing Address - Fax:580-336-5801
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:580-336-5801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERRY MEMORIAL HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-31
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7095251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377445Medicare Oscar/Certification