Provider Demographics
NPI:1245391846
Name:MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH
Other - Org Name:COUNTY OF TILLMAN-CITY OF FREDERICK MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:HOME HEALTH OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-335-6631
Mailing Address - Street 1:319 E. JOSEPHINE AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-2220
Mailing Address - Country:US
Mailing Address - Phone:580-335-6631
Mailing Address - Fax:580-335-6607
Practice Address - Street 1:319 E JOSEPHINE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-2220
Practice Address - Country:US
Practice Address - Phone:580-335-7565
Practice Address - Fax:580-335-7329
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL & PHYSICIAN GROUP HOME HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7128251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK377056Medicare Oscar/Certification