Healthcare Provider Details

I. General information

NPI: 1720066434
Provider Name (Legal Business Name): HEARTWAY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S YORK ST
MUSKOGEE OK
74403
US

IV. Provider business mailing address

500 S YORK ST
MUSKOGEE OK
74403-5956
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-6724
  • Fax: 918-682-8090
Mailing address:
  • Phone: 918-682-6724
  • Fax: 918-682-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH5112-5112
License Number StateOK

VIII. Authorized Official

Name: KATHY SUZETTE BAUCOM
Title or Position: TREASURER
Credential:
Phone: 580-286-1065