Healthcare Provider Details

I. General information

NPI: 1164432316
Provider Name (Legal Business Name): MERIDIAN HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT. 2 BOX 335
COMANCHE OK
73529-9650
US

IV. Provider business mailing address

RT. 2 BOX 335
COMANCHE OK
73529-9650
US

V. Phone/Fax

Practice location:
  • Phone: 580-439-2398
  • Fax: 580-439-5870
Mailing address:
  • Phone: 580-439-2398
  • Fax: 580-439-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH6908-6908
License Number StateOK

VIII. Authorized Official

Name: MR. TOM C COBLE
Title or Position: MANAGING MEMBER
Credential: PARTNER
Phone: 580-226-3055