MEDICARE: THERAWEST 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	225100000X	Physical Therapist	2536	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500522222	OTHER	OK	MEDICARE MSP
3	500522222	OTHER	OK	MEDICARE CROSSOVER CLAIMS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	73159	OTHER	OK	THE KEMPTON CO
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	73159	OTHER	OK	FIRST HEALTH/ KEMPTON CO.

General Provider Information

NPI Number	:	1700087079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERAWEST LLC

Provider Business Mailing Address
First Line	:	PO BOX 86
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-0086
Country	:	US
Telephone Number	:	580-323-8778
Fax Number	:	580-323-8732

Provider Business Practice Location Address
First Line	:	509 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3632
Country	:	US
Telephone Number	:	580-323-8778
Fax Number	:	866-490-4693

Authorized Official
Title or Position	:	BILLING/CREDENTIALING SPECIALIST
Name	:	LORA ANN RUIZ
Credential	:
Telephone Number	:	580-275-2194

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	01/19/2025

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Directions to “THERAWEST LLC ” Practice Location

Language	Start Address	Practice Location

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