Wagoner Care Center LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

100771420A Issued in OK

Legal business name

WAGONER CARE CENTER LLC

Doing business as

Wagoner Care Center

Practice address

205 N Lincoln Ave
Wagoner, OK 74467-3915

Phone

(918) 485-2203

Fax

(918) 485-6673

NPI assigned

Feb 7, 2007

Last updated

Jan 20, 2012By 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

Justin Price

Title

Member

Phone

(918) 967-9285

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Wagoner Care Center Doing business as

Locations

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1225178429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N LINCOLN AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744673915",
            "telephone_number": "918-485-2203",
            "fax_number": "918-485-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N LINCOLN AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744673915",
            "telephone_number": "918-485-2203",
            "fax_number": "918-485-6673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "PRICE",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "918-967-9285"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "100771420A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100771420A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagoner Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Wagoner, OK
• Providers in Wagoner, 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 20, 2012; 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.