SCG Madill Brookside LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH4801-4801 Issued in OK

Legal business name

SCG MADILL BROOKSIDE LLC

Doing business as

Brookside Nursing Center

Practice address

310 Brookside Dr
Highway 377
Madill, OK 73446-9047

Phone

(580) 795-2100

Fax

(580) 677-9918

NPI assigned

Oct 18, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Kevin C Goyer Jr.

Title

President

Phone

(813) 341-2700

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brookside Nursing Center Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shawna Rose Hardison, PTA

  • Physical Therapy Assistant
  • Madill, OK
  • NPI 1780716688
  NPD (past)
• Stacy James Rendon, COTA

  • Occupational Therapy Assistant
  • Madill, OK
  • NPI 1629100524
  NPD (past)

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1699764100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1240 MARBELLA PLAZA DR.",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336197905",
            "telephone_number": "813-341-2700",
            "fax_number": "813-676-0127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 BROOKSIDE DR",
            "address_2": "HIGHWAY 377",
            "city": "MADILL",
            "state": "OK",
            "postal_code": "734469047",
            "telephone_number": "580-795-2100",
            "fax_number": "580-677-9918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCG MADILL BROOKSIDE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "GOYER",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-341-2700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": "NH4801-4801",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100776200A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebecca Robertson, MS LPC
• Linda D Robins
• Lauren Rodriguez, PHARM D
• Bryan Rowley
• Tanya Royal
• Brandy N Schultz
• Deborah Leah Self, M.S.,C.C.C.
• Heather Michelle Shores
• Sharon Shumaker Smith
• Southeastern Oklahoma Family Services, Inc.

• Skilled Nursing Facility in Madill, OK
• Providers in Madill, 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 Jul 17, 2014; 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.