Provider Demographics
NPI:1851630404
Name:PURCELL MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:PURCELL MUNICIPAL HOSPITAL
Other - Org Name:FAMILY MEDICINE OF PURCELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-527-2207
Mailing Address - Street 1:PO BOX 511
Mailing Address - Street 2:
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-0511
Mailing Address - Country:US
Mailing Address - Phone:405-527-6524
Mailing Address - Fax:405-527-6963
Practice Address - Street 1:1401 N 4TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1806
Practice Address - Country:US
Practice Address - Phone:405-527-9314
Practice Address - Fax:405-527-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty