Provider Demographics
NPI:1245430073
Name:DYNAMICARE
Entity Type:Organization
Organization Name:DYNAMICARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:918-720-3442
Mailing Address - Street 1:1409 E RENO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-9380
Mailing Address - Country:US
Mailing Address - Phone:918-720-3442
Mailing Address - Fax:918-355-1330
Practice Address - Street 1:1409 E RENO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-9380
Practice Address - Country:US
Practice Address - Phone:918-720-3442
Practice Address - Fax:918-355-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTA748251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health