Healthcare Provider Details

I. General information

NPI: 1700137551
Provider Name (Legal Business Name): MIAMI HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 NORTH ELM ST.
MIAMI OK
74354
US

IV. Provider business mailing address

2530 NORTH ELM ST.
MIAMI OK
74354
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-2300
  • Fax: 918-540-2525
Mailing address:
  • Phone: 918-540-2300
  • Fax: 918-540-2525

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: JUSTIN MCGREW
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-775-4439