MEDICARE: WADLEY CARE CENTER

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	375286	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972509172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WADLEY CARE CENTER

Provider Business Mailing Address
First Line	:	P.O. BOX 1675
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080-1675
Country	:	US
Telephone Number	:	405-527-7798
Fax Number	:	405-527-5175

Provider Business Practice Location Address
First Line	:	801 N. 6TH STREET
Second Line	:
City	:	PURCELL
State	:	OK
Zip	:	73080
Country	:	US
Telephone Number	:	405-527-7798
Fax Number	:	405-527-5175

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID WADLEY
Credential	:
Telephone Number	:	405-527-7798

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	11/01/2013

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Directions to “WADLEY CARE CENTER ” Practice Location

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