Provider Demographics
NPI:1801833223
Name:MERCY HOSPITAL ARDMORE INC
Entity Type:Organization
Organization Name:MERCY HOSPITAL ARDMORE INC
Other - Org Name:MERCY HOME HEALTH ARDMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-220-6238
Mailing Address - Street 1:1011 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1828
Mailing Address - Country:US
Mailing Address - Phone:580-220-6560
Mailing Address - Fax:580-220-6463
Practice Address - Street 1:1012 14TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1807
Practice Address - Country:US
Practice Address - Phone:580-220-6560
Practice Address - Fax:580-220-6463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL ARDMORE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-02
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7248251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100262320AMedicaid
OK377121Medicare ID - Type Unspecified