JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY NPI 1407230790

NPI Information

NPI: 1407230790
Provider Name: JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY

Doing Business As: JCMH PEDIATRIC CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
101 S PARK LN
SUITE 100
ALTUS, OK
ZIP 73521
Phone: (580) 379-6100
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JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY is a rural health clinic center in Altus, OK. JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY NPI is 1407230790. The provider is registered as an organization entity type.
The provider Is Doing Business As Jcmh Pediatric Clinic.

The provider's business location address is:

101 S PARK LN
SUITE 100
ALTUS, OK
ZIP 73521-731
Phone: (580) 379-6100
Fax: (580) 379-6109

The provider's authorized official is Steve Hartgraves .
The authorized official title is President/ceo and has the following contact phone number (580) 379-5500.

The CLIA number assigned to this NPI record is 37D1030473 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/16/2015 and was last updated on 10/6/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200688750A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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