MEDICARE: RURAL HEALTHCARE OF OKLAHOMA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		OK

General Provider Information

NPI Number	:	1144546011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RURAL HEALTHCARE OF OKLAHOMA, INC

Provider Business Mailing Address
First Line	:	2815 E JACKSON ST
Second Line	:
City	:	HUGO
State	:	OK
Zip	:	74743-4250
Country	:	US
Telephone Number	:	816-729-2740
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 E JACKSON ST
Second Line	:
City	:	HUGO
State	:	OK
Zip	:	74743-4250
Country	:	US
Telephone Number	:	816-729-2740
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ROBERT BERRY
Credential	:
Telephone Number	:	512-626-2751

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	06/14/2010

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