Perry Memorial Hospital Authority

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

2268 Issued in OK

Legal business name

PERRY MEMORIAL HOSPITAL AUTHORITY

Doing business as

Community Medical Clinic

Practice address

501 N 14TH St
Perry, OK 73077-5021

Phone

(580) 336-2176

Fax

(580) 336-3178

NPI assigned

Oct 12, 2016

Organization subpart

No

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

Authorized official

Name

Mr. John Fuller

Title

Chairman of the Board

Phone

(580) 336-2176

Specialties & licenses 1

Addresses

Other names 1

• Community Medical Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Stillwater Medical Center Authority

  • Rural Health Clinic/Center
  • Perry, OK
  • NPI 1972005981

  Sold to, 2018-04-01

  CMS change of ownership

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

{
    "created_epoch": "1476230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476230400000",
    "number": "1861942948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1318 ELM ST",
            "city": "PERRY",
            "state": "OK",
            "postal_code": "730775034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N 14TH ST",
            "city": "PERRY",
            "state": "OK",
            "postal_code": "730775021",
            "telephone_number": "580-336-2176",
            "fax_number": "580-336-3178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERRY MEMORIAL HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-12",
        "last_updated": "2016-10-12",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "580-336-2176",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "2268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Perry Green Valley Nursing Home Inc
• Perry Green Valley Nursing Home LLC
• Perry Memorial Hospital Authority
• Perry Memorial Hospital Authority
• Perry Memorial Hospital Authority
• Perry School District
• Perry Smiles
• Perry Wellness Center PLLC
• PFD PLLC
• Maegan Phillips

• Family Medicine Physician in Perry, OK
• Providers in Perry, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.