Provider Demographics
NPI:1851472922
Name:MEDICALODGES, INC.
Entity Type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:MEDICALODGES DEWEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-709-0305
Mailing Address - Street 1:430 BARTLES ROAD
Mailing Address - Street 2:P.O. BOX 520
Mailing Address - City:DEWEY
Mailing Address - State:OK
Mailing Address - Zip Code:74029-0520
Mailing Address - Country:US
Mailing Address - Phone:918-534-2848
Mailing Address - Fax:918-534-2558
Practice Address - Street 1:430 BARTLES ROAD
Practice Address - Street 2:
Practice Address - City:DEWEY
Practice Address - State:OK
Practice Address - Zip Code:74029-0520
Practice Address - Country:US
Practice Address - Phone:918-534-2848
Practice Address - Fax:918-534-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH74047404314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100773540AMedicaid
OK100773540AMedicaid