1669460507 NPI number — DUNCAN MANOR INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669460507 NPI number — DUNCAN MANOR INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUNCAN MANOR 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:
DUNCAN CARE 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:
1669460507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 PALM DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNCAN
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73533-3324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-522-9000
Provider Business Mailing Address Fax Number:
580-255-0565

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 PALM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNCAN
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73533-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-522-9000
Provider Business Practice Location Address Fax Number:
580-255-0565
Provider Enumeration Date:
10/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PITA
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE/MEDICARE
Authorized Official Telephone Number:
580-622-6300

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  NH6902-6902 , 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: 200059960A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000375484001 . This is a "BLUE CROSS BLUE SHIELD OK" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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