Provider Demographics
NPI:1952309064
Name:STATE OF OKLAHOMA
Entity Type:Organization
Organization Name:STATE OF OKLAHOMA
Other - Org Name:BOARD OF REGENTS FOR THE UNIV OF OK ON BEHALF OF GEORGE NIGH REHAB CTR
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-266-2470
Mailing Address - Street 1:900 E AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447
Mailing Address - Country:US
Mailing Address - Phone:918-266-2470
Mailing Address - Fax:918-756-9452
Practice Address - Street 1:900 E AIRPORT RD
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-1118
Practice Address - Country:US
Practice Address - Phone:918-266-2470
Practice Address - Fax:918-756-9452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF OKLAHOMA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-12
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2318283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1006936508Medicaid
OK373026Medicare Oscar/Certification
OK375314Medicare Oscar/Certification
OKGRGNGHRHBMedicare PIN