Provider Demographics
NPI:1942287339
Name:MDR HEALTH GROUP LLC
Entity Type:Organization
Organization Name:MDR HEALTH GROUP LLC
Other - Org Name:ONEHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-682-4194
Mailing Address - Street 1:1624 W OKMULGEE ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-6743
Mailing Address - Country:US
Mailing Address - Phone:918-682-4194
Mailing Address - Fax:918-682-4088
Practice Address - Street 1:1624 W OKMULGEE ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-6743
Practice Address - Country:US
Practice Address - Phone:918-682-4194
Practice Address - Fax:918-682-4088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDR HEALTH GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-27
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7809251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7809OtherHOME CARE AGENCY LICENSE
OK7809OtherHOME CARE AGENCY LICENSE