Provider Demographics
NPI:1083617807
Name:NEWMAN MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:NEWMAN MEMORIAL HOSPITAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:MAJORS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:580-938-2551
Mailing Address - Street 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858-9205
Mailing Address - Country:US
Mailing Address - Phone:580-938-2551
Mailing Address - Fax:580-938-2615
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858
Practice Address - Country:US
Practice Address - Phone:580-938-2551
Practice Address - Fax:580-938-2615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2243282NC0060X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127341905Medicaid
OK100699360AMedicaid
OK000370007001OtherBLUE CROSS
OK100699360BMedicaid
TX073846001Medicaid
TX127341901Medicaid
TX127341901Medicaid
OK37U007Medicare Oscar/Certification
OK000370007001OtherBLUE CROSS
=========73858000OtherCHAMPUS