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Mangum City Hospital Authority

Organization Active NPI Critical Access Hospital · Mangum, OK

NPI 1033635263 · NPPES record last updated Jul 21, 2022

Key facts

NPI
1033635263
Entity type
Organization (NPI type 2)
Primary specialty
Critical Access Hospital 282NC0060X
Legal business name
MANGUM CITY HOSPITAL AUTHORITY
Practice address
1 Wickersham St
Mangum, OK 73554-9117
Phone
(580) 782-3353
NPI assigned
Aug 18, 2017
Organization subpart
No

Authorized official

Name
Andrea Snider
Title
Controller
Phone
(580) 782-3353

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Affiliated clinicians 12

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Medicare Care Compare: Hospital

Listed as
Mangum Regional Medical Center CCN 371330
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (3 enrollments) in OK

Hospital certification: CCN 371330

Legal name
MANGUM CITY HOSPITAL AUTHORITY
Doing business as
MANGUM REGIONAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Apr 1, 2005
Last certification
Nov 11, 2021
Beds
18
Ownership / control type
Hospital district or authority
Most recent change of ownership
Oct 1, 2005 (1 total)
Organization structure
Other · Non-profit
Enrollment address
1 Wickersham St
Mangum, OK 73554-9117
Other Hospital Practice Location

Hospital certification: CCN 37Z330

Legal name
MANGUM CITY HOSPITAL AUTHORITY
Doing business as
MANGUM REGIONAL MEDICAL CENTER
Organization structure
Other · Non-profit
Enrollment address
1 Wickersham St
Mangum, OK 73554-9117
Other Hospital Practice Location

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kelley Martinez
Individual 		Operational/Managerial Control
Ceo		 Jun 1, 2023
Mangum City Hospital Authority
Organization · Mangum, OK 		5% Or Greater Direct Ownership Interest Jul 1, 1997 100%
Operational/Managerial Control Jul 1, 1997 100%
Cohesive Healthcare Management and Consulting LLC
Organization · Shawnee, OK
LLC, Management services company 		Operational/Managerial Control Mar 1, 2021
Danielle Cooper
Individual 		W-2 Managing Employee
Business Office Lead		 Jan 1, 2023

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mangum City Hospital Authority
Mangum, OK · CCN 378541		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Sep 22, 2019

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170905000055 OK Part a Provider - Critical Access Hospital 6305119942 Receives reassigned benefits from 15 practitioners
Practice locations: Mangum, OK
O20180228000171 OK Part a Provider - Critical Access Hospital 6305119942 Receives reassigned benefits from 1 practitioner
Practice locations: Mangum, OK
O20181020000126 OK Part B Supplier - Clinic/Group Practice 6305119942 Receives reassigned benefits from 39 practitioners
Practice locations: Mangum, OK

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X OK Yes

Addresses

Primary practice location

1 Wickersham St
Mangum, OK 73554-9117

Mailing address

PO Box 280
Mangum, OK 73554-0280
Phone (580) 782-3353

Other names

  • Mangum Regional Medical Center Doing business as

Other providers in Mangum, OK

All providers in Mangum, OK · Critical Access Hospital in Oklahoma

Sources for this page

Verify at the official NPI Registry.