Provider Demographics
NPI:1972780765
Name:ADAIR COUNTY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:ADAIR COUNTY HEALTH CENTER, INC.
Other - Org Name:MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-696-3101
Mailing Address - Street 1:1401 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3217
Mailing Address - Country:US
Mailing Address - Phone:918-696-3101
Mailing Address - Fax:918-696-3388
Practice Address - Street 1:1401 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3217
Practice Address - Country:US
Practice Address - Phone:918-696-3101
Practice Address - Fax:918-696-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2180261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972780765OtherNPI
OK100700030BMedicaid
=========Medicare PIN