Provider Demographics
NPI:1528302957
Name:QUARTZ MOUNTIAN MEDICAL CENTER
Entity type:Organization
Organization Name:QUARTZ MOUNTIAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABB
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:1580-782-3353
Mailing Address - Street 1:1 WICKERSHAM ST
Mailing Address - Street 2:
Mailing Address - City:MANGUM
Mailing Address - State:OK
Mailing Address - Zip Code:73554-9117
Mailing Address - Country:US
Mailing Address - Phone:580-782-3353
Mailing Address - Fax:580-782-5944
Practice Address - Street 1:118 S LOUIS TITTLE AVE
Practice Address - Street 2:
Practice Address - City:MANGUM
Practice Address - State:OK
Practice Address - Zip Code:73554-4441
Practice Address - Country:US
Practice Address - Phone:580-782-2113
Practice Address - Fax:580-782-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR 0057113282NC0060X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access