MEDICARE: EAGLE'S WINGS PROGRAM

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	251B00000X	Case Management Agency		OK

General Provider Information

NPI Number	:	1821431578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE'S WINGS PROGRAM

Provider Business Mailing Address
First Line	:	5700 N EVEREST AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-6732
Country	:	US
Telephone Number	:	405-213-5952
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 N EVEREST AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-6732
Country	:	US
Telephone Number	:	405-213-5952
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF EAGLE'S WINGS
Name	:	MRS. LOIS FELDER
Credential	:
Telephone Number	:	405-840-1359

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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