IHS Wynnewood Care Center LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

NH2506-2506 Issued in OK

Legal business name

IHS WYNNEWOOD CARE CENTER LLC

Doing business as

Wynnewood Care Center

Practice address

131 N Broadway Ave
Ada, OK 74820-5003

Phone

(580) 436-0950

Fax

(580) 436-0953

NPI assigned

Sep 10, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Bart Taylor Reed

Title

President

Phone

(580) 436-0950

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Wynnewood Care Center Doing business as

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190592000000",
    "number": "1548455975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 E CALIFORNIA ST",
            "city": "WYNNEWOOD",
            "state": "OK",
            "postal_code": "730983207",
            "telephone_number": "405-665-2330",
            "fax_number": "405-943-4917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 N BROADWAY AVE",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748205003",
            "telephone_number": "580-436-0950",
            "fax_number": "580-436-0953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHS WYNNEWOOD CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2007-09-24",
        "status": "A",
        "authorized_official_last_name": "REED",
        "authorized_official_first_name": "BART",
        "authorized_official_middle_name": "TAYLOR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-436-0950",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "OK",
            "license": "NH2506-2506",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH2506-2506",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007767770A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wynnewood Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2007; 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.