Provider Demographics
NPI:1245236652
Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:PERRY MEMORIAL HOSPITAL AUTHORITY
Other - Org Name:PERRY MEMORIAL HOSPITAL
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:580-336-2176
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:580-336-7209
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:580-336-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700900AMedicaid
OK100700900BMedicaid