Healthcare Provider Details

I. General information

NPI: 1497761159
Provider Name (Legal Business Name): LONG TERM CARE SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 NW 132ND ST
OKLAHOMA CITY OK
73142-4437
US

IV. Provider business mailing address

5721 NW 132ND ST
OKLAHOMA CITY OK
73142-4437
US

V. Phone/Fax

Practice location:
  • Phone: 405-557-1200
  • Fax: 405-557-1977
Mailing address:
  • Phone: 405-557-1200
  • Fax: 405-557-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN HERNDON
Title or Position: BILLING DIRECTOR
Credential:
Phone: 405-557-1200