GRADY MEMORIAL HOSPITAL NPI 1164859260

NPI Information

NPI: 1164859260
Provider Name: GRADY MEMORIAL HOSPITAL

Doing Business As: FIVE OAKS FAMILY MEDICAL CLINIC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 37D2067845

Address:
2100 W IOWA AVE
SUITE A
CHICKASHA, OK
ZIP 73018
Phone: (405) 224-2100
Get Directions

GRADY MEMORIAL HOSPITAL is a rural health clinic center in Chickasha, OK. GRADY MEMORIAL HOSPITAL NPI is 1164859260. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Five Oaks Family Medical Clinic.

The provider's business location address is:

2100 W IOWA AVE
SUITE A
CHICKASHA, OK
ZIP 73018-736
Phone: (405) 224-2100
Fax: (405) 779-2346

The provider's authorized official is Warren Kean Spellman .
The authorized official title is Ceo and has the following contact phone number (405) 779-2150.

The CLIA number assigned to this NPI record is 37D2067845 - rural health clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/3/2013 and was last updated on 9/5/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	207Q00000X	Family Medicine		OKLAHOMA	No
2	207V00000X	Obstetrics & Gynecology		OKLAHOMA	No
3	261QR1300X	Clinic/Center	Rural Health	OKLAHOMA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	100700820 K	MEDICAID	OKLAHOMA
2	409956	MEDICARE PIN	OKLAHOMA
3	373478	MEDICARE OSCAR/CERTIFICATION	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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