MEDICARE: GORE HEALTH SERVICES, 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	313M00000X	Nursing Facility/Intermediate Care Facility		OK

General Provider Information

NPI Number	:	1487683959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GORE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1929 BETTY JANE LN
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74403-1581
Country	:	US
Telephone Number	:	918-683-9407
Fax Number	:	918-683-1979

Provider Business Practice Location Address
First Line	:	503 S MAIN ST
Second Line	:
City	:	GORE
State	:	OK
Zip	:	74435-2010
Country	:	US
Telephone Number	:	918-489-2299
Fax Number	:	918-489-2806

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCHUYLER MONTGOMERY
Credential	:
Telephone Number	:	918-683-9407

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/21/2022

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Directions to “GORE HEALTH SERVICES, LLC ” Practice Location

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