MEDICARE: MIAMI HEALTHCARE, LLC

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

General Provider Information

NPI Number	:	1700137551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	2530 NORTH ELM ST.
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354
Country	:	US
Telephone Number	:	918-540-2300
Fax Number	:	918-540-2525

Provider Business Practice Location Address
First Line	:	2530 NORTH ELM ST.
Second Line	:
City	:	MIAMI
State	:	OK
Zip	:	74354
Country	:	US
Telephone Number	:	918-540-2300
Fax Number	:	918-540-2525

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JUSTIN MCGREW
Credential	:
Telephone Number	:	918-775-4439

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	04/18/2019

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Directions to “MIAMI HEALTHCARE, LLC ” Practice Location

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