Provider Demographics
NPI:1568978708
Name:MANGUM CITY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:MANGUM CITY HOSPITAL AUTHORITY
Other - Org Name:MANGUM FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-782-3353
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-0280
Mailing Address - Country:US
Mailing Address - Phone:580-782-2000
Mailing Address - Fax:580-782-5103
Practice Address - Street 1:118 S LOUIS TITTLE AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4441
Practice Address - Country:US
Practice Address - Phone:580-782-2000
Practice Address - Fax:580-782-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health