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General NPI Number Information
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NPI Number | 1437301512
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Entity Type | Organization
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Legal Business Name | PROMISE MCLOUD LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 701 S 8TH ST
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City | MCLOUD
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State | OK
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Zip | 74851-8500
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Country | US
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Telephone | 405-964-2962
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Fax |
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Provider Business Mailing Address
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Address Line | 701 S 8TH ST
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City | MCLOUD
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State | OK
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Zip | 74851-8500
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Country | US
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Telephone | 405-964-2962
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | STEPHEN C. THOMPSON
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Credential |
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Telephone | 405-573-7908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | NH6309-6309
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License Number State | OK
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