MEDICARE: IHS STONEGATE NURSING CENTER 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	NH6205-6205	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	:	1417954900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHS STONEGATE NURSING CENTER INC

Provider Business Mailing Address
First Line	:	130 E 6TH STREET
Second Line	:
City	:	STONEWALL
State	:	OK
Zip	:	74871-0277
Country	:	US
Telephone Number	:	580-436-0950
Fax Number	:	580-436-0950

Provider Business Practice Location Address
First Line	:	130 E 6TH STREET
Second Line	:
City	:	STONEWALL
State	:	OK
Zip	:	74871-0277
Country	:	US
Telephone Number	:	580-436-0950
Fax Number	:	580-436-0950

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BART T REED
Credential	:
Telephone Number	:	580-436-0950

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	12/23/2009

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