1336194349 NPI number — PEAK MEDICAL OKLAHOMA NO. 7, INC.

Table of content: (NPI 1336194349)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336194349 NPI number — PEAK MEDICAL OKLAHOMA NO. 7, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEAK MEDICAL OKLAHOMA NO. 7, INC.
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:
HARRAH NURSING CENTER
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:
1336194349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SUN AVE NE
Provider Second Line Business Mailing Address:
COMPLIANCE DEPARTMENT
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-5604
Provider Business Mailing Address Fax Number:
505-468-4681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 WHITES MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRAH
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73045-9402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-454-6255
Provider Business Practice Location Address Fax Number:
405-454-6257
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATHIES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT DIRECTOR
Authorized Official Telephone Number:
505-821-3355

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH55515551 , 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: 100779120A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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