Provider Demographics
NPI:1487683959
Name:GORE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:GORE HEALTH SERVICES, LLC
Other - Org Name:COMMUNITY HEALTHCARE OF GORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCHUYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-683-9407
Mailing Address - Street 1:1929 BETTY JANE LN
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-1581
Mailing Address - Country:US
Mailing Address - Phone:918-683-9407
Mailing Address - Fax:918-683-1979
Practice Address - Street 1:503 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GORE
Practice Address - State:OK
Practice Address - Zip Code:74435-2010
Practice Address - Country:US
Practice Address - Phone:918-489-2299
Practice Address - Fax:918-489-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375295Medicare ID - Type Unspecified