Meadow Brook Icfmr

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

MEADOW BROOK ICFMR

Practice address

1200 Meadow Lane
Howe, OK 74940

Phone

(918) 658-3656

Fax

(918) 658-3967

NPI assigned

Dec 11, 2006

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

Ms. Tabitha Sue Bundy

Title

Administrator

Phone

(918) 658-3656

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902966112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 MEADOW LANE",
            "city": "HOWE",
            "state": "OK",
            "postal_code": "74940",
            "telephone_number": "918-658-3656",
            "fax_number": "918-658-3967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MEADOW LANE",
            "city": "HOWE",
            "state": "OK",
            "postal_code": "74940",
            "telephone_number": "918-658-3656",
            "fax_number": "918-658-3967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEADOW BROOK ICFMR",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUNDY",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "918-658-3656",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROVIDER NUMBER",
            "identifier": "37G117",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Marie Martin
• Doug Victor Mathis
• Kaitlin Brady May
• Lacey Michelle McClain
• Meadow Brook Icf/Mr #2
• Meadow Brook Outpatient Treatment Center
• Meadow Brook Residential Care Facility
• Amber B Melton, RN
• Blaine Miller
• Michelle Miller, MASTERS

• Intellectual Disabilities Intermediate Care Facility in Howe, OK
• Providers in Howe, OK by specialty
• Intellectual Disabilities Intermediate Care 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.