Basic Information
| Provider Information | |||||||||
| NPI: | 1083617807 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEWMAN MEMORIAL HOSPITAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHATTUCK | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738589205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809382551 | ||||||||
| FaxNumber: | 5809382615 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SHATTUCK | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809382551 | ||||||||
| FaxNumber: | 5809382615 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 05/14/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MAJORS | ||||||||
| AuthorizedOfficialFirstName: | EDDIE | ||||||||
| AuthorizedOfficialMiddleName: | JACKSON | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5809382551 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | CEO | ||||||||
| NPICertificationDate: | 05/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 2243 | OK | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 127341905 | 05 | TX | MEDICAID | 100699360A | 05 | OK | MEDICAID | 000370007001 | 01 | OK | BLUE CROSS | OTHER | 100699360B | 05 | OK | MEDICAID | 073846001 | 05 | TX | MEDICAID | 127341901 | 05 | TX | MEDICAID |