Poteau Nursing Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH40094009 Issued in OK

Legal business name

POTEAU NURSING CENTER, LLC

Practice address

1501 Clayton Ave
Poteau, OK 74953-4102

Phone

(918) 647-8236

Fax

(918) 649-3747

NPI assigned

Oct 20, 2005

Organization subpart

No

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

Authorized official

Name

Mark Lietzke

Title

Ceo

Phone

(918) 622-4799

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 2

• The Oaks Health Care Center Poteau Doing business as
• The Oaks Healthcare Center Doing business as

Tax ID family

Poteau Nursing Center LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The Oaks Healthcare Center - Poteau, LLC

  • Skilled Nursing Facility
  • Poteau, OK
  • NPI 1164990008
  NPD tax ID

Locations

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629936000000",
    "number": "1154310399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 E 15TH ST",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741044610",
            "telephone_number": "918-622-4799",
            "fax_number": "918-622-4798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 CLAYTON AVE",
            "city": "POTEAU",
            "state": "OK",
            "postal_code": "749534102",
            "telephone_number": "918-647-8236",
            "fax_number": "918-649-3747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POTEAU NURSING CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A",
        "authorized_official_last_name": "LIETZKE",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "918-622-4799"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH40094009",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100847080A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDEDR ID",
            "identifier": "000375166001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Oaks Health Care Center Poteau",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Oaks Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Oaks Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Lee Plummer, MA
• Dustin Mathew Porter, M.D.
• Poteau Community Care
• Poteau Eye Care LLC
• Poteau Family Pharmacy, LLC
• Poteau School District
• Poteau Vision Source, PC
• Jayden A Potter
• Tori Prince
• Pro Care Family Health of Leflore County

• Skilled Nursing Facility in Poteau, OK
• Providers in Poteau, 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 Aug 26, 2021; 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.