1033341698 NPI number — MANOR CARE OF MIDWEST CITY OK LLC

Table of content: (NPI 1033341698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033341698 NPI number — MANOR CARE OF MIDWEST CITY OK LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANOR CARE OF MIDWEST CITY OK LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MANORCARE HEALTH SERVICES - MIDWEST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033341698
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N SUMMIT ST
Provider Second Line Business Mailing Address:
ATTN BARRY A LAZARUS
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-252-5541
Provider Business Mailing Address Fax Number:
419-254-5494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 PARKLAWN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73110-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-737-6601
Provider Business Practice Location Address Fax Number:
405-737-4984
Provider Enumeration Date:
08/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LAZARUS
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VICE PRESIDENT - REIMBURSEMENT
Authorized Official Telephone Number:
419-252-5541

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH55125512 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200268710A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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