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CAH371330-01 MANGUM REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
MANGUM REGIONAL MEDICAL CENTER
Subdivision Name
MANGUM CITY HOSPITAL AUTHORITY - Mangum Family Clinic
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH371330-01
Medicare Provider Number
371330
Outpatient Facility Provider Number
378541
Additional Details
Current Program Status
Active
Registration Date
1/5/2022
Participating Start Date
4/1/2022
Participating Approval Date
1/13/2022
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Mangum Regional Medical Center
Kelley Martinez, CEO
(580) 782-3353 Ext: 249
Primary Contact
Cohesive Healthcare Management & Consulting
Miranda Walz-Allen, Project Manager
(620) 213-2125
Addresses
Street Address
118 S LOUIS TITTLE AVE
MANGUM CLINIC
MANGUM, OK 73554-4441
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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