MEDICARE: BEDLAM PROPERTIES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1093836280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEDLAM PROPERTIES, LLC

Provider Business Mailing Address
First Line	:	1805 E 15TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4610
Country	:	US
Telephone Number	:	918-622-4799
Fax Number	:	918-622-4798

Provider Business Practice Location Address
First Line	:	1805 E 15TH ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74104-4610
Country	:	US
Telephone Number	:	918-622-4799
Fax Number	:	918-622-4798

Authorized Official
Title or Position	:	CEO
Name	:	MR. MARK LIETZKE
Credential	:
Telephone Number	:	918-622-4799

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/26/2021

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Directions to “BEDLAM PROPERTIES, LLC ” Practice Location

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