Provider Demographics
NPI:1073510913
Name:SPIRO NURSING HOME, INC.
Entity Type:Organization
Organization Name:SPIRO NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-962-2308
Mailing Address - Street 1:401 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPIRO
Mailing Address - State:OK
Mailing Address - Zip Code:74959-2601
Mailing Address - Country:US
Mailing Address - Phone:918-962-2308
Mailing Address - Fax:918-962-2033
Practice Address - Street 1:401 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPIRO
Practice Address - State:OK
Practice Address - Zip Code:74959-2601
Practice Address - Country:US
Practice Address - Phone:918-962-2308
Practice Address - Fax:918-962-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH-4005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375258Medicare Oscar/Certification