Healthcare Provider Details

I. General information

NPI: 1225025455
Provider Name (Legal Business Name): MICHAEL F FLANAGAN, RECEIVER FOR MEDFORS NURSING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 S FRONT ST
MEDFORD OK
73759-1714
US

IV. Provider business mailing address

616 S FRONT ST
MEDFORD OK
73759-1714
US

V. Phone/Fax

Practice location:
  • Phone: 580-395-2105
  • Fax: 580-395-2070
Mailing address:
  • Phone: 580-395-2105
  • Fax: 580-395-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH27022702
License Number StateOK

VIII. Authorized Official

Name: MICHAEL F FLANAGAN
Title or Position: CORPORATE ATTORNEY
Credential:
Phone: 816-444-0900