Provider Demographics
NPI:1700869492
Name:ARBUCKLE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:ARBUCKLE MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-622-2161
Mailing Address - Street 1:PO BOX 1109
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-8109
Mailing Address - Country:US
Mailing Address - Phone:580-622-2161
Mailing Address - Fax:580-622-6455
Practice Address - Street 1:2011 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4221
Practice Address - Country:US
Practice Address - Phone:580-622-2161
Practice Address - Fax:580-622-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2278282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700790AMedicaid
OK100700790DMedicaid
OK=========Medicare PIN