MEDICARE: PEAK MEDICAL OKLAHOMA NO. 7, INC.

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	NH55515551	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336194349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEAK MEDICAL OKLAHOMA NO. 7, INC.

Provider Business Mailing Address
First Line	:	101 SUN AVE NE
Second Line	:	COMPLIANCE DEPARTMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87109-4373
Country	:	US
Telephone Number	:	505-468-5604
Fax Number	:	505-468-4681

Provider Business Practice Location Address
First Line	:	2400 WHITES MEADOW DR
Second Line	:
City	:	HARRAH
State	:	OK
Zip	:	73045-9402
Country	:	US
Telephone Number	:	405-454-6255
Fax Number	:	405-454-6257

Authorized Official
Title or Position	:	PRESIDENT DIRECTOR
Name	:	WILLIAM A MATHIES
Credential	:
Telephone Number	:	505-821-3355

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	10/15/2008

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