Basic Information
Provider Information | |||||||||
NPI: | 1003354689 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 520 MEDICAL DR | ||||||||
Address2: |   | ||||||||
City: | GUYMON | ||||||||
State: | OK | ||||||||
PostalCode: | 739424438 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4055097370 | ||||||||
FaxNumber: | 4055097373 | ||||||||
Practice Location | |||||||||
Address1: | 1800 RENAISSANCE BLVD | ||||||||
Address2: | SECOND FLOOR TOWER, SUITE 210 | ||||||||
City: | EDMOND | ||||||||
State: | OK | ||||||||
PostalCode: | 730133023 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4055097370 | ||||||||
FaxNumber: | 4055097373 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2017 | ||||||||
LastUpdateDate: | 02/03/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZINN | ||||||||
AuthorizedOfficialFirstName: | TROY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 5803383113 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 4343 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
No ID Information.