Provider Demographics
NPI:1710973854
Name:ALTERNACARE INC
Entity Type:Organization
Organization Name:ALTERNACARE INC
Other - Org Name:ALTERNACARE OF TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:918-682-7773
Mailing Address - Street 1:3404 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-5071
Mailing Address - Country:US
Mailing Address - Phone:918-627-7773
Mailing Address - Fax:918-628-0496
Practice Address - Street 1:10120 E 91ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5830
Practice Address - Country:US
Practice Address - Phone:918-627-7773
Practice Address - Fax:918-628-0496
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTERNACARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-23
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK73-0797681-003OtherBCBS SUPPLIER ID
OK100804760HMedicaid
OK0140880004Medicare NSC