1548037641 NPI number — BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC

Table of content: DR. DIANAH THELMA LAKE MD (NPI 1003952375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548037641 NPI number — BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST VILLAGE RETIREMENT COMMUNITIES 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:
Provider Other Organization Name Type Code:
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:
1548037641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 JOHNNY BENCH DR STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104-2470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-724-2872
Provider Business Mailing Address Fax Number:
405-942-0018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 N OAKWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENID
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73703-9344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-249-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2023

Additional Information

Authorized Official

Authorized Official Last Name:
SHORT
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
405-942-3000

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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