Provider Demographics
NPI:1598964637
Name:PURCELL MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:PURCELL MUNICIPAL HOSPITAL
Other - Org Name:MAYSVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-527-6524
Mailing Address - Street 1:504 WILLIAMS STREET
Mailing Address - Street 2:P.O. BOX 660
Mailing Address - City:MAYSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:73057-0660
Mailing Address - Country:US
Mailing Address - Phone:405-867-4404
Mailing Address - Fax:405-867-4520
Practice Address - Street 1:504 WILLIAMS STREET
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:OK
Practice Address - Zip Code:73057-0660
Practice Address - Country:US
Practice Address - Phone:405-867-4404
Practice Address - Fax:405-867-4520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURCELL MUNICIPAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-17
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699900LMedicaid
OK373977Medicare Oscar/Certification