JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY (NPI# 1093199382) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093199382 |
| Entity Type | Organization |
| Organization Name | JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY |
| Other Organization Name | JCMH FAMILYCARE MEDICAL CLINIC OF MANGUM |
| Practice Address |
114 S Louis Tittle Ave Mangum OK 73554-4406 |
| Mailing Address |
1200 E Pecan St Altus OK 73521-6141 |
| Practice Telephone | 5807823393 |
| Mailing Telephone | 5803795000 |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-16 |
| Authorized Official Name | MR. STEVE HARTGRAVES (CEO) |
| Authorized Official Telephone | 5803795500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| JCMH FAMILYCARE MEDICAL CLINIC OF MANGUM | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699724757 | Jackson County Memorial Hospital Authority | Home Health | 1204 E Tamarack Rd, Altus, OK 73521-1234 | 2006-05-08 |
| 1962978916 | Jackson County Memorial Hospital Authority | Clinic/Center | 304 S Park Ln Ste B, Altus, OK 73521-5754 | 2018-10-17 |
| 1245614387 | Jackson County Memorial Hospital Authority | Clinic/Center | 205 S Park Ln, Altus, OK 73521-5755 | 2015-07-18 |
| 1972987014 | Jackson County Memorial Hospital Authority | Clinic/Center | 101 S Park Ln, Suite 200, Altus, OK 73521-5731 | 2015-07-18 |
| 1407230790 | Jackson County Memorial Hospital Authority | Clinic/Center | 101 S Park Ln, Suite 100, Altus, OK 73521-5731 | 2015-07-16 |
| 1912138553 | Jackson County Memorial Hospital Authority | Clinic/Center | 1001 Us Highway 83 N, Childress, TX 79201-2322 | 2009-07-30 |
| 1003094129 | Jackson County Memorial Hospital Authority | General Acute Care Hospital | 400 E Chestnut St, Hollis, OK 73550-2030 | 2008-01-31 |
| 1235170754 | Jackson County Memorial Hospital Authority | Hospice Care, Community Based | 1204 E Tamarack Rd, Altus, OK 73521-1234 | 2006-06-08 |
| 1093763781 | Jackson County Memorial Hospital Authority | General Acute Care Hospital | 1200 E Pecan St, Altus, OK 73521-6141 | 2006-05-04 |
| 1295735991 | Jackson County Memorial Hospital Authority | General Acute Care Hospital | 400 E Chestnut St, Hollis, OK 73550-2030 | 2005-07-26 |
| Street Address |
114 S LOUIS TITTLE AVE |
| City | MANGUM |
| State | OK |
| Zip Code | 73554-4406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487650750 | Patricia Anne Burks | Nurse Practitioner | 114 S Louis Tittle Ave, Mangum, OK 73554-4406 | 2005-06-22 |
| 1831652007 | Ashley Brooke Slaton | Nurse Practitioner | 114 S Louis Tittle Ave, Mangum, OK 73554-4406 | 2019-04-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750845145 | Traci L Carrier | Licensed Practical Nurse | 115 S Lincoln St., Mangum, OK 73554 | 2019-01-30 |
| 1194295741 | Ez Sleep Solutions, Inc. | Dentist | 230 E. Jefferson, Mangum, OK 73554 | 2018-11-27 |
| 1881122976 | Lexie Noel Turner | Case Manager/Care Coordinator | 115 E Lincoln, Mangum, OK 73554 | 2017-06-01 |
| 1740640648 | Yco Tulsa, Inc. | Clinic/Center | 2100 North Louis Tittle, Suites 122-124 and 147-148, Mangum, OK 73554 | 2016-03-04 |
| 1750748984 | Teryl Pearson | Counselor | 2 Wickersham Dr., New Hope Recovery Center, Mangum, OK 73554 | 2016-01-19 |
| 1437525532 | Kiley Reneah Bachelder | Case Manager/Care Coordinator | 2 Wichersham Drive, Mangum, OK 73554 | 2015-08-12 |
| 1376941732 | Dana Juarez | Marriage & Family Therapist | 2100 N Louis Tittle, Mangum, OK 73554 | 2014-12-16 |
| 1033388509 | Blackhawk Mangum, LLC | Clinic/Center | 118 South Louis Tittle, Mangum, OK 73554 | 2008-02-28 |
| 1104008168 | Blackhawk Mangum LLC | Medicare Defined Swing Bed Unit | One Wickersham Drive, Mangum, OK 73554 | 2007-12-03 |
| 1336356500 | Patrecia Ann Fite | Nurse Practitioner | 2100 North Louis Tittle Ave, Box 1, Mangum, OK 73554 | 2007-05-17 |
| Find all providers in zip 73554 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
| 1093312548 | Prime Health Associates, Pllc | Clinic/Center | 2511 Alexa Ave, Edmond, OK 73034-3458 | 2020-10-07 |
| 1598387524 | Thomas E. Cashero Md LLC | Clinic/Center | 90 N 30th St Ste 5, Clinton, OK 73601-3100 | 2020-05-13 |
| 1184271793 | Healthy Skin Dermatology of Oklahoma Pllc | Clinic/Center | 13933 Technology Dr Ste B, Oklahoma City, OK 73134-1053 | 2019-08-20 |
| 1922572809 | Endovascular Consulting Solutions | Clinic/Center | 1705 E 19th St Ste 410, Tulsa, OK 74104-5415 | 2019-01-14 |
| 1831610641 | Scot A Sullivan Md PC | Clinic/Center | 2020 E 15th St Ste B, Edmond, OK 73013-6749 | 2017-06-30 |
| 1053862102 | Okc Neurology-catherine E Porter Md, Pllc | Clinic/Center | 6701 W Hefner Rd Ste B, Oklahoma City, OK 73162-4706 | 2016-10-24 |
| 1730584509 | Digital Diagnostic Solutions LLC | Clinic/Center | 5017 S Frontage Road, Tulsa, OK 74107-8976 | 2014-10-23 |
| 1891102331 | Panhandle Counseling and Health Center, Inc. | Clinic/Center | 5170 Patricia Blvd, Guymon, OK 73942-0000 | 2014-07-16 |
| 1922350719 | Allergy Arts of Oklahoma Pllc | Clinic/Center | 3300 Nw 56th St Ste 100, Oklahoma City, OK 73112-4538 | 2012-10-04 |
| 1255699112 | Meghan E. Scears, Md, Pllc | Clinic/Center | 808 24th Ave Nw Ste 202, Norman, OK 73069-6204 | 2012-04-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.