Provider Demographics
NPI:1851669865
Name:PURCELL MUNICIPAL HOSPITAL
Entity Type:Organization
Organization Name:PURCELL MUNICIPAL HOSPITAL
Other - Org Name:PURCELL NUCLEAR MEDICINE, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-527-6524
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 1:1500 N GREEN AVE
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-1642
Practice Address - Country:US
Practice Address - Phone:405-527-6524
Practice Address - Fax:405-527-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2280282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK370158Medicare Oscar/Certification