Provider Demographics
NPI:1275657017
Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC
Entity Type:Organization
Organization Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL MANAGEMENT, INC
Other - Org Name:CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DUNNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-654-1050
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:OK
Mailing Address - Zip Code:73015
Mailing Address - Country:US
Mailing Address - Phone:580-654-1050
Mailing Address - Fax:580-654-2111
Practice Address - Street 1:102 N. BROADWAY
Practice Address - Street 2:
Practice Address - City:CARNEGIE
Practice Address - State:OK
Practice Address - Zip Code:73015
Practice Address - Country:US
Practice Address - Phone:580-654-1050
Practice Address - Fax:580-654-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK102208D00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699690CMedicaid
OK200522010Medicare PIN
OK900522058Medicare PIN