SCG Lake Country LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH4301-4301 Issued in OK

Legal business name

SCG LAKE COUNTRY LLC

Doing business as

Lake Country Nursing Center

Practice address

401 C E Colston Dr
Marietta, OK 73448-1230

Phone

(580) 276-3318

Fax

(580) 276-2100

NPI assigned

Aug 9, 2005

Last updated

Jan 22, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Daniel Vaughan

Title

President

Phone

(813) 341-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Lake Country Nursing Center Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264118400000",
    "number": "1033110457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 MARBELLA PLAZA DR.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336197905",
            "telephone_number": "813-341-2700",
            "fax_number": "813-676-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 C E COLSTON DR",
            "city": "MARIETTA",
            "state": "OK",
            "postal_code": "734481230",
            "telephone_number": "580-276-3318",
            "fax_number": "580-276-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCG LAKE COUNTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2010-01-22",
        "status": "A",
        "authorized_official_last_name": "VAUGHAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-341-2700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH4301-4301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776270A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Country Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia Owens, FNP
• Doris Jean Petty, RN
• Melinda Sue Pitts, R.N.
• Larry Dean Powell, M.D.
• Mariana Sanchez
• Charles Reid Schnorrenberg, RPH
• Emilie Theresa Stahler, DDS
• Komal Noor Kaur Uppal, FNP
• Cheryl Washburn, CPTA
• Dorothy Willis

• Skilled Nursing Facility in Marietta, OK
• Providers in Marietta, OK by specialty
• Skilled Nursing Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.