Provider Demographics
NPI:1821318668
Name:REYNOLDS ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:REYNOLDS ARMY COMMUNITY HOSPITAL
Other - Org Name:FRONTIER MEDICAL HOME-SILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHITTUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-558-2793
Mailing Address - Street 1:3009 NW WILSON STREET
Mailing Address - Street 2:ATTN MCUA-PAD-PF - BILLING OFFICE
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-458-2793
Mailing Address - Fax:
Practice Address - Street 1:5404 SW LEE BLVD
Practice Address - Street 2:FRONTIER MEDICAL HOME-SILL
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9695
Practice Address - Country:US
Practice Address - Phone:580-558-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REYNOLDS ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-03
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487752960OtherPARENT FACILITY NPI 2
OTH000Medicare UPIN
VAD000Medicare UPIN