Basic Information
| Provider Information | |||||||||
| NPI: | 1770711061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEMORIAL HOSPITAL OF TEXAS COUNTY AUTHORITY | ||||||||
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| OtherOrganizationName: | HIGH PLAINS INTERNAL MEDICINE AND FAMILY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 739424438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803386515 | ||||||||
| FaxNumber: | 5804683442 | ||||||||
| Practice Location | |||||||||
| Address1: | 1753 N ROOSEVELT ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | GUYMON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 739422729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804683035 | ||||||||
| FaxNumber: | 5804683037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| AuthorizedOfficialLastName: | ZINN | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5803383113 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100699630I | 05 | OK | MEDICAID |