GRADY MEMORIAL HOSPITAL NPI 1750715439

NPI Information

NPI: 1750715439
Provider Name: GRADY MEMORIAL HOSPITAL

Doing Business As: TUTTLE FAMILY MEDICAL CLINIC

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

Specialization: Rural Health

CLIA Number: 37D2071035

Address:
4805 E HIGHWAY 37
TUTTLE, OK
ZIP 73089
Phone: (405) 381-2301
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GRADY MEMORIAL HOSPITAL is a rural health clinic center in Tuttle, OK. GRADY MEMORIAL HOSPITAL NPI is 1750715439. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Tuttle Family Medical Clinic.

The provider's business location address is:

4805 E HIGHWAY 37
TUTTLE, OK
ZIP 73089-791
Phone: (405) 381-2301
Fax: (405) 381-3592

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 37D2071035 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/29/2013 and was last updated on 9/15/2022.

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	Primary
1	207Q00000X	Family Medicine		No
2	261Q00000X	Clinic/Center		No
3	261QR1300X	Clinic/Center	Rural Health	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	Other Provider Identifier Issuer
1	100700820P	MEDICAID	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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