Broadway Manor Management L.L.C

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BROADWAY MANOR MANAGEMENT L.L.C

Doing business as

Broadway Manor Nursing Home

Practice address

1622 E Broadway St
Muskogee, OK 74403-4601

Phone

(918) 683-2851

Fax

(918) 683-2992

NPI assigned

Jul 20, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Thornton Scott

Title

Managing Member

Phone

(918) 683-2851

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Broadway Manor Nursing Home Doing business as

Locations

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700885787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 E BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034601",
            "telephone_number": "918-683-2851",
            "fax_number": "918-683-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 E BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744034601",
            "telephone_number": "918-683-2851",
            "fax_number": "918-683-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MANOR MANAGEMENT L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "THORNTON",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "918-683-2851",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000375146001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bright Smiles Pediatric Dental of Muskogee LLC
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• Felicia Lauren Brittle
• Dawn Melody Brizendine
• Broadway Healthcare, LLC
• Broadway Vision Associates, PLC
• William Nelson Brock
• Scarlet Bronson
• Joshua Warren Brooks
• Lavette Brooks, RN

• Skilled Nursing Facility in Muskogee, OK
• Providers in Muskogee, 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 Aug 22, 2020; 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.