Provider Demographics
NPI:1073763736
Name:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Other - Org Name:ROGER MILLS AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-497-3336
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:OK
Mailing Address - Zip Code:73628-0219
Mailing Address - Country:US
Mailing Address - Phone:580-497-3336
Mailing Address - Fax:580-497-2124
Practice Address - Street 1:501 S LL MALES
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:OK
Practice Address - Zip Code:73628-0219
Practice Address - Country:US
Practice Address - Phone:580-497-3336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS063341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK730761094001OtherBLUE CROSS BLUE SHIELD