Wickshire Oklahoma City Opco LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

WICKSHIRE OKLAHOMA CITY OPCO LLC

Doing business as

Wickshire Oklahoma City

Practice address

12310 South Western Avenue
Oklahoma City, OK 73170

Phone

(405) 691-6555

NPI assigned

Apr 23, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Dan O'Keefe

Title

Ceo

Phone

(615) 942-0240

Specialties & licenses 2

Addresses

Other names 1

• Wickshire Oklahoma City Doing business as

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

{
    "created_epoch": "1619136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619136000000",
    "number": "1386226827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 OLD HICKORY BLVD",
            "address_2": "BUILDING ONE SUITE 125",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "37027",
            "telephone_number": "615-942-0240",
            "fax_number": "615-806-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12310 SOUTH WESTERN AVENUE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73170",
            "telephone_number": "405-691-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WICKSHIRE OKLAHOMA CITY OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-23",
        "last_updated": "2021-04-23",
        "certification_date": "2021-04-23",
        "status": "A",
        "authorized_official_last_name": "O'KEEFE",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-942-0240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wickshire Oklahoma City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth A Wickersham, M.D.
• Dayton Wickham
• Ryan Wicks, MD
• Taylor Wicks
• Teresa C Wicks
• Mylla Jaylynn Wickwire, PHARM.D.
• Elizabeth H. Widaski, RN
• Jimmy L Widdifield Jr., M.A., LPC
• Jeremy Eugene Widener, DO
• Frank J. Wiebelt, D.D.S.

• Assisted Living Facility in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Assisted Living Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.