Provider Demographics
NPI:1316065584
Name:MEMORIAL HOSPITAL & PHYSICIAN'S GROUP HOME HEALTH CARE
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL & PHYSICIAN'S GROUP HOME HEALTH CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HILBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-335-6631
Mailing Address - Street 1:319 E. JOSEPHINE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542
Mailing Address - Country:US
Mailing Address - Phone:580-335-6631
Mailing Address - Fax:580-335-6607
Practice Address - Street 1:319 E JOSEPHINE AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-2220
Practice Address - Country:US
Practice Address - Phone:580-335-7565
Practice Address - Fax:580-335-7325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEMORIAL HOSPITAL & PHYSICIAN'S GROUP HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7746164W00000X, 376J00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100700940FMedicaid
OK100700940GMedicaid