Provider Demographics
NPI:1285611756
Name:BEAVER COUNTY MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:BEAVER COUNTY MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-625-4551
Mailing Address - Street 1:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:TURPIN
Mailing Address - State:OK
Mailing Address - Zip Code:73950-0299
Mailing Address - Country:US
Mailing Address - Phone:580-778-3966
Mailing Address - Fax:580-778-3890
Practice Address - Street 1:104 N HIBBS
Practice Address - Street 2:
Practice Address - City:TURPIN
Practice Address - State:OK
Practice Address - Zip Code:73950-0299
Practice Address - Country:US
Practice Address - Phone:580-778-3966
Practice Address - Fax:580-778-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2242261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700760GMedicaid
OK100700760HMedicaid
OK100700760GMedicaid
OK37-3408Medicare PIN