Healthcare Provider Details

I. General information

NPI: 1114590098
Provider Name (Legal Business Name): MADILL OPERATING CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 BROOKSIDE DR
MADILL OK
73446-3638
US

IV. Provider business mailing address

1908 12TH AVE NW STE E
ARDMORE OK
73401-1255
US

V. Phone/Fax

Practice location:
  • Phone: 580-795-2100
  • Fax: 580-677-9918
Mailing address:
  • Phone: 580-226-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: TOM C. COBLE
Title or Position: MANAGER
Credential:
Phone: 580-220-7093