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NPI Code Detail

MEDICARE: PEAK MEDICAL OKLAHOMA NO. 4, INC.

MEDICARE: PEAK MEDICAL OKLAHOMA NO. 4, 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
1311500000XAlzheimer Center (Dementia Center)NH55325532OK
2314000000XSkilled Nursing FacilityNH55325532OK

Other Identifiers

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

General Provider Information

NPI Number : 1356396048
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEAK MEDICAL OKLAHOMA NO. 4, 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 : 5725 S ROSS AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-5650
Country : US
Telephone Number : 405-685-4791
Fax Number : 405-685-0232
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : WILLIAM A. MATHIES
Credential :
Telephone Number : 505-821-3355
Provider Enumeration Date : 05/23/2006
Last Update Date : 09/28/2009

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