Provider Demographics
NPI:1750629671
Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY
Other - Org Name:HIGH PLAINS GENERAL SURGICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-338-6515
Mailing Address - Street 1:520 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:GUYMON
Mailing Address - State:OK
Mailing Address - Zip Code:73942-4438
Mailing Address - Country:US
Mailing Address - Phone:580-338-6515
Mailing Address - Fax:580-468-3442
Practice Address - Street 1:1753 N ROOSEVELT ST STE 1
Practice Address - Street 2:
Practice Address - City:GUYMON
Practice Address - State:OK
Practice Address - Zip Code:73942-2729
Practice Address - Country:US
Practice Address - Phone:580-468-3035
Practice Address - Fax:580-468-3442
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL OF TEXAS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-28
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty