MEDICARE: SEMINOLE NURSING HOME 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	313M00000X	Nursing Facility/Intermediate Care Facility	NH6704-6704	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
2	000375350001	OTHER	OK	BLUE CROSS BLUE SHIELD OK

General Provider Information

NPI Number	:	1578550331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMINOLE NURSING HOME INC

Provider Business Mailing Address
First Line	:	1705 BOREN BLVD
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-2725
Country	:	US
Telephone Number	:	405-382-1270
Fax Number	:	405-382-3199

Provider Business Practice Location Address
First Line	:	1705 BOREN BLVD
Second Line	:
City	:	SEMINOLE
State	:	OK
Zip	:	74868-2725
Country	:	US
Telephone Number	:	405-382-1270
Fax Number	:	405-382-3199

Authorized Official
Title or Position	:	INSURANCE/MEDICARE
Name	:	JANICE PITA
Credential	:
Telephone Number	:	580-622-6300

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	06/16/2008

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Directions to “SEMINOLE NURSING HOME INC ” Practice Location

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