Provider Demographics
NPI:1093709628
Name:SOUTHEASTERN OKLAHOMA OUTPATIENT REHAB
Entity Type:Organization
Organization Name:SOUTHEASTERN OKLAHOMA OUTPATIENT REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-614-4402
Mailing Address - Street 1:PO BOX 3070
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75504-3070
Mailing Address - Country:US
Mailing Address - Phone:903-735-5356
Mailing Address - Fax:903-735-5399
Practice Address - Street 1:1425 LINCOLN RD
Practice Address - Street 2:SUITE B-3
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-7345
Practice Address - Country:US
Practice Address - Phone:580-286-4842
Practice Address - Fax:903-735-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK441764286001OtherBLUE CROSS
OK376600Medicare ID - Type Unspecified