Provider Demographics
NPI:1558489641
Name:OKMULGEE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:OKMULGEE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:LEA
Authorized Official - Last Name:HAMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-4233
Mailing Address - Street 1:1401 MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6429
Mailing Address - Country:US
Mailing Address - Phone:918-756-4233
Mailing Address - Fax:918-758-3766
Practice Address - Street 1:1401 MORRIS DR
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6429
Practice Address - Country:US
Practice Address - Phone:918-756-4233
Practice Address - Fax:918-758-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2165275N00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37U057Medicare Oscar/Certification