Organization
JACKSON COUNTY MEMORIAL HOSPITAL AUTHORITY
Active
Other names
JCMH Pediatric Clinic, JCMH PEDIATRIC CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEVE HARTGRAVES (PRESIDENT/CEO)
(580) 379-5500
Entity
Organization
Contact information
Practice address
101 S PARK LN, SUITE 100, ALTUS, OK 73521-5731
(580) 379-6100
(580) 379-6109
Mailing address
1200 E PECAN ST, ALTUS, OK 73521-6141
(580) 379-5000
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200688750A
—
OK
Enumeration date
07/16/2015
Last updated
10/06/2022
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