Healthcare Provider Details

I. General information

NPI: 1740273317
Provider Name (Legal Business Name): HEALTHWAY HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S ADAIR ST
PRYOR OK
74361-5201
US

IV. Provider business mailing address

PO BOX 985
PRYOR OK
74362-0985
US

V. Phone/Fax

Practice location:
  • Phone: 918-825-6151
  • Fax: 918-825-6151
Mailing address:
  • Phone: 918-825-6151
  • Fax: 918-825-6151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. RUSSELL I DEVERS
Title or Position: PRESIDENT
Credential: RCP
Phone: 918-825-6151