Waynoka Nursing Center Authority

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH7603-7603 Issued in OK

Legal business name

WAYNOKA NURSING CENTER AUTHORITY

Practice address

2601 Broadway St
Waynoka, OK 73860-6812

Phone

(580) 824-5661

Fax

(580) 824-5662

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Tom Leatherman

Title

Administrator

Phone

(580) 824-5661

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327968000000",
    "number": "1316059645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 BROADWAY ST",
            "city": "WAYNOKA",
            "state": "OK",
            "postal_code": "738606812",
            "telephone_number": "580-824-5661",
            "fax_number": "580-824-5662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 BROADWAY ST",
            "city": "WAYNOKA",
            "state": "OK",
            "postal_code": "738606812",
            "telephone_number": "580-824-5661",
            "fax_number": "580-824-5662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAYNOKA NURSING CENTER AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-01-31",
        "status": "A",
        "authorized_official_last_name": "LEATHERMAN",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-824-5661"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH7603-7603",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100777950A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bethany S Stout, LADC
• The Medical Clinic, Inc
• Patti Jo Vazquez, LCSWUNDER SUPERVISI
• Waynoka Mental Health Authority (Northwest Treatment Center)
• Waynoka Mental Health Authority (Northwest Substance Abuse Treatment Center)
• Shelly Marie Wingo

• Nursing Facility/Intermediate Care Facility in Waynoka, OK
• Providers in Waynoka, OK by specialty
• Nursing Facility/Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.