Provider Demographics
NPI:1578540274
Name:BEAVER COUNTY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:BEAVER COUNTY MEMORIAL HOSPITAL
Other - Org Name:COMMUNITY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-625-4551
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-0640
Mailing Address - Country:US
Mailing Address - Phone:580-625-4551
Mailing Address - Fax:580-625-4212
Practice Address - Street 1:212 E 8TH ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3184
Practice Address - Country:US
Practice Address - Phone:580-625-4551
Practice Address - Fax:580-625-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282NC0060X, 332B00000X, 333600000X, 3336C0002X, 3336C0003X, 3336C0004X, 3336L0003X
OK6930293336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700760AMedicaid
OK100700760AMedicaid
2074450OtherPK
OK90003921830Medicaid
OK371322Medicare Oscar/Certification