NPIMap

Organization Active NPI

Beaver County Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Beaver, OK
National Provider Identifier
1356529903
Registry record updated Feb 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
2242 Issued in OK
Legal business name
BEAVER COUNTY MEMORIAL HOSPITAL
Practice address
212 East 8TH Street
Beaver, OK 73932-0640
Phone
(580) 625-4551
Fax
(580) 625-4212
NPI assigned
Feb 6, 2008
Last updated
Feb 6, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brent Meyers
Title
Administrator
Phone
(580) 625-4551

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 2242 OK Primary

Addresses

Primary practice location

212 East 8TH Street
Beaver, OK 73932-0640

Mailing address

P.O. Box 640
Beaver, OK 73932-0640
Phone (580) 625-4551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080527000777 OK Part A Provider - Critical Access Hospital 9335134246 Receives reassigned benefits from 1 practitioner
Practice locations: Beaver, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356529903. Details of each certification follow.

Hospital certification: CCN 37Z322

Legal name
BEAVER COUNTY MEMORIAL HOSPITAL
Organization structure
OtherNon-profit
Enrollment address
212 East 8TH Street
Beaver, OK 73932-0640
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Beaver Cnty Memorial Hosp5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

212 E 8th St
Beaver, OK 73932
Phone (580) 625-3646

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Karla Leisher Individual W-2 Managing Employee Nov 19, 2007
Alissa Schlessman Individual Corporate Officer Jul 2, 2013
Corporate Director Jul 2, 2013
Beaver County Memorial Hospital Organization, Beaver, OK 5% Or Greater Direct Ownership Interest Jan 1, 1966
Operational/Managerial Control Jan 1, 1966

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1202256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202256000000",
    "number": "1356529903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 640",
            "city": "BEAVER",
            "state": "OK",
            "postal_code": "739320640",
            "telephone_number": "580-625-4551",
            "fax_number": "580-625-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 EAST 8TH STREET",
            "city": "BEAVER",
            "state": "OK",
            "postal_code": "739320640",
            "telephone_number": "580-625-4551",
            "fax_number": "580-625-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-06",
        "last_updated": "2008-02-06",
        "status": "A",
        "authorized_official_last_name": "MEYERS",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-625-4551"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "OK",
            "license": "2242",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver, OK

Sources for this page

Verify at the official NPI Registry.