MEDICARE: NURSING CENTER OF THE SOUTHWEST 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	NH3305-3305	OK

General Provider Information

NPI Number	:	1891728820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSING CENTER OF THE SOUTHWEST LLC

Provider Business Mailing Address
First Line	:	2610 CEDAR CREEK DR
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-1312
Country	:	US
Telephone Number	:	580-480-1800
Fax Number	:	580-477-2006

Provider Business Practice Location Address
First Line	:	2610 CEDAR CREEK DR
Second Line	:
City	:	ALTUS
State	:	OK
Zip	:	73521-1312
Country	:	US
Telephone Number	:	580-480-1800
Fax Number	:	580-477-2006

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. B. WADE BRINKMAN
Credential	:
Telephone Number	:	580-480-1800

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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