# COUNTY OF TILLMAN - CITY OF FREDERICK HOSPITAL AUTHORITY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COUNTY OF TILLMAN-CITY OF FRE
- **Other names:** Memorial Hospital
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679550115
- **Legal business name:** COUNTY OF TILLMAN-CITY OF FRE
- **Authorized official:** MR. RYAN D. ADE PT (BOARD CHAIRMAN)
- **Authorized official phone:** (580) 335-6642

## Contact information

- **Practice address:** 319 E JOSEPHINE AVENUE, FREDERICK, OK 73542-2220
- **Practice address phone:** (580) 335-6600
- **Practice address fax:** (580) 335-5044
- **Mailing address:** 319 E JOSEPHINE AVENUE, FREDERICK, OK 73542-2220
- **Mailing address phone:** (580) 335-6600
- **Mailing address fax:** (580) 335-5044

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 7103 | OK | — |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/27/2005
- **Last updated:** 06/20/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 10076110B | — | OK |
| 05 | — | 100776110B | — | OK |