Provider Demographics
NPI:1144205360
Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-338-6515
Mailing Address - Street 1:520 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942
Mailing Address - Country:US
Mailing Address - Phone:580-338-3113
Mailing Address - Fax:580-468-3442
Practice Address - Street 1:520 MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942
Practice Address - Country:US
Practice Address - Phone:580-338-3113
Practice Address - Fax:580-468-3442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2249282N00000X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699630AMedicaid
OK100699630CMedicaid
OK100699630CMedicaid
OK37U138Medicare Oscar/Certification
OK370138Medicare PIN
OK370138Medicare UPIN
OK370138Medicare Oscar/Certification