NPIMap

Organization Active NPI

Indian Territory Long Term Care, Inc.

Doing business as Indian Territory Provider Care Plus

  • Public Health or Welfare Agency
  • Tishomingo, OK
National Provider Identifier
1457481426
Registry record updated Nov 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
100627980B Issued in OK
Legal business name
INDIAN TERRITORY LONG TERM CARE, INC.
Doing business as
Indian Territory Provider Care Plus
Practice address
105 N Neshoba St
Tishomingo, OK 73460-1739
Phone
(580) 371-0015
Fax
(580) 371-3204
NPI assigned
Mar 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2008

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

Authorized official

Name
Mr. Jayson Earl Northcutt
Title
Chief Operations Officer
Phone
(580) 371-2106

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X 100627980B OK Primary

Addresses

Primary practice location

105 N Neshoba St
Tishomingo, OK 73460-1739

Mailing address

105 N Neshoba St
Tishomingo, OK 73460-1739
Phone (580) 371-0015

Other identifiers 1

IdentifierTypeStateIssuer
100627980BMedicaidOK

Other names 1

  • Indian Territory Provider Care Plus Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Indian Territory Long Term Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227139200000",
    "number": "1457481426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N NESHOBA ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601739",
            "telephone_number": "580-371-0015",
            "fax_number": "580-371-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N NESHOBA ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601739",
            "telephone_number": "580-371-0015",
            "fax_number": "580-371-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN TERRITORY LONG TERM CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-11-20",
        "status": "A",
        "authorized_official_last_name": "NORTHCUTT",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "580-371-2106",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "OK",
            "license": "100627980B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100627980B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian Territory Provider Care Plus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tishomingo, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; 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.