Healthcare Provider Details

I. General information

NPI: 1700826377
Provider Name (Legal Business Name): PEAK MEDICAL OKLAHOMA NO. 10, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E. WRANGLER BLVD.
SEMINOLE OK
74868-3595
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-1127
  • Fax: 405-382-1129
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberNH67066706
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH67066706
License Number StateOK

VIII. Authorized Official

Name: WILLIAM A. MATHIES
Title or Position: PRESIDENT DIRECTOR
Credential:
Phone: 505-821-3355