Beaver County Memorial Hospital
Organization Active NPI Durable Medical Equipment & Medical Supplies · Beaver, OK
NPI 1013195684 · NPPES record last updated Feb 14, 2020
Key facts
- NPI
- 1013195684
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- License
- 693029 (OK)
- Legal business name
- BEAVER COUNTY MEMORIAL HOSPITAL
- Practice address
- 212 East 8TH Street
Beaver, OK 73932 - Phone
- (580) 625-3646
- Fax
- (580) 625-3844
- NPI assigned
- Feb 6, 2008
- Organization subpart
- No
Authorized official
- Name
- Alissa Schlessman
- Title
- Administrator
- Phone
- (580) 625-4551
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Practitioners 10
-
Ashley Nicole Johnston, APRN
-
Scotty King, APRN, FNP-C
-
James E Scalia Jr., PA-C
-
Jennifer Sparks, FNP-CNP
-
Lynnetta Faye Stout, APRN-CNP
-
Donny Wynn, M.D.
-
Roy Kent Rogers, PA-C
-
Aaron Scott Sizelove, D.O.
-
Susan Danielle Trippet, ARNP
-
Hinakumari David Rey, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Beaver County Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest Operational/Managerial Control |
Jan 1, 1966 Jan 1, 1966 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060815000248 | OK | Part B Supplier - Mass Immunization (Roster Biller Only) | 9335134246 |
1 other NPI on this enrollment Practice locations: Beaver, OK |
| O20100930007152 | OK | DME Supplier - Pharmacy | 9335134246 | Practice locations: Beaver, OK |
National Provider Directory
- Tax ID family
- Beaver County Mem Hosp PC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 693029 | OK | Yes |
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X | 693029 | OK | |
| Oxygen Equipment & Supplies (DME) | 332BX2000X | 693029 | OK | |
| Community/Retail Pharmacy | 3336C0003X | 693029 | OK | |
| Institutional Pharmacy | 3336I0012X | 693029 | OK | |
| Long Term Care Pharmacy | 3336L0003X | 693029 | OK | |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
212 East 8TH Street
Beaver, OK 73932
Mailing address
PO Box 640
Beaver, OK 73932-0640
Phone (580) 625-3646
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90003921830 | Medicaid | OK | |
| 100700760C | Medicaid | OK |
Other names
- Community Pharmacy
Other providers in Beaver, OK
- James Arney
- Beaver County Memorial Hospital
- Beaver County Memorial Hospital
- Beaver County Memorial Hospital
- Beaver County Memorial Hospital
- Beaver County Memorial Hospital
All providers in Beaver, OK · Durable Medical Equipment & Medical Supplies in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.