MEDICARE: DAVID'S HEALTH 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	251E00000X	Home Health Agency	7384	OK

General Provider Information

NPI Number	:	1801958244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID'S HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	200 N. MAIN ST.
Second Line	:	P.O. BOX 116
City	:	FORT TOWSON
State	:	OK
Zip	:	74735-0116
Country	:	US
Telephone Number	:	580-873-2876
Fax Number	:	580-873-2841

Provider Business Practice Location Address
First Line	:	200 N. MAIN ST.
Second Line	:
City	:	FORT TOWSON
State	:	OK
Zip	:	74735-0116
Country	:	US
Telephone Number	:	580-873-2876
Fax Number	:	580-873-2841

Authorized Official
Title or Position	:	C.F.O.
Name	:	MR. JERRY WAYNE DAVID
Credential	:
Telephone Number	:	580-873-2876

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	01/03/2012

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