MEDICARE: MDR HEALTH GROUP 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	251E00000X	Home Health Agency	7809	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7809	OTHER	OK	HOME CARE AGENCY LICENSE

General Provider Information

NPI Number	:	1942287339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MDR HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	1637 S GEORGE NIGH EXPY STE A2
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-7424
Country	:	US
Telephone Number	:	918-302-3797
Fax Number	:	918-420-5249

Provider Business Practice Location Address
First Line	:	1637 S GEORGE NIGH EXPY STE A2
Second Line	:
City	:	MCALESTER
State	:	OK
Zip	:	74501-7424
Country	:	US
Telephone Number	:	918-682-4194
Fax Number	:	918-682-4088

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. CARLA MUSICK
Credential	:	LPN
Telephone Number	:	580-298-9932

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/10/2024

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Directions to “MDR HEALTH GROUP LLC ” Practice Location

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