Provider Demographics
NPI:1760583942
Name:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Other - Org Name:ROGER MILLS MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-497-3336
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:OK
Mailing Address - Zip Code:73628-0219
Mailing Address - Country:US
Mailing Address - Phone:580-497-3336
Mailing Address - Fax:580-497-2778
Practice Address - Street 1:501 S LL MALES
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:OK
Practice Address - Zip Code:73628
Practice Address - Country:US
Practice Address - Phone:580-497-3336
Practice Address - Fax:580-497-2778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGER MILLS COUNTY HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-26
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100699820DMedicaid
OK=========Medicare PIN
OK=========Medicare ID - Type UnspecifiedPART B