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NPI Code Detail

MEDICARE: PEAK MEDICAL OKLAHOMA NO. 3, INC.

MEDICARE: PEAK MEDICAL OKLAHOMA NO. 3, 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
1311500000XAlzheimer Center (Dementia Center)NH72447244OK
2314000000XSkilled Nursing FacilityNH72447244OK

General Provider Information

NPI Number : 1225084270
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEAK MEDICAL OKLAHOMA NO. 3, INC.
Provider Business Mailing Address
First Line : 101 SUN AVE NE
Second Line : COMPLIANCE DEPARTMENT
City : ALBUQUERQUE
State : NM
Zip : 87109-4373
Country : US
Telephone Number : 505-468-5604
Fax Number : 505-468-4681
Provider Business Practice Location Address
First Line : 4300 W HOUSTON ST
Second Line :
City : BROKEN ARROW
State : OK
Zip : 74012-4519
Country : US
Telephone Number : 918-254-5000
Fax Number : 918-250-2538
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : WILLIAM A. MATHIES
Credential :
Telephone Number : 505-821-3355
Provider Enumeration Date : 05/25/2006
Last Update Date : 09/28/2009

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Directions to “PEAK MEDICAL OKLAHOMA NO. 3, INC. ” Practice Location

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