1285626424 NPI number — RURAL HEALTHCARE OF OKLAHOMA, INC

Table of content: (NPI 1285626424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285626424 NPI number — RURAL HEALTHCARE OF OKLAHOMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RURAL HEALTHCARE OF OKLAHOMA, 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:
LANE FROST HEALTH AND REHABILITATION 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:
1285626424
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2815 E JACKSON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUGO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74743-4250
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-326-9200
Provider Business Mailing Address Fax Number:
580-317-2810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2815 E JACKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74743-4250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-326-9200
Provider Business Practice Location Address Fax Number:
580-317-2810
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
512-626-2751

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2353 , 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: 200042180A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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