MEDICARE: THE ATOKA GROUP, 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	NH0302-0302	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

General Provider Information

NPI Number	:	1942366810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ATOKA GROUP, LLC

Provider Business Mailing Address
First Line	:	1901 RICKETY LN
Second Line	:	STE 208
City	:	TYLER
State	:	TX
Zip	:	75703-1702
Country	:	US
Telephone Number	:	903-534-8667
Fax Number	:	903-509-0026

Provider Business Practice Location Address
First Line	:	1500 S VIRGINIA AVE
Second Line	:
City	:	ATOKA
State	:	OK
Zip	:	74525-3246
Country	:	US
Telephone Number	:	580-889-2500
Fax Number	:	580-889-2888

Authorized Official
Title or Position	:	CFO
Name	:	CARLA POWER
Credential	:
Telephone Number	:	903-534-8667

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	08/22/2020

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Directions to “THE ATOKA GROUP, LLC ” Practice Location

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