Provider Demographics
NPI:1184795171
Name:CENTRAL PULMONARY REHAB, LLC
Entity type:Organization
Organization Name:CENTRAL PULMONARY REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DUKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-841-0088
Mailing Address - Street 1:7429 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-3201
Mailing Address - Country:US
Mailing Address - Phone:405-841-0088
Mailing Address - Fax:405-841-0099
Practice Address - Street 1:7429 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-3201
Practice Address - Country:US
Practice Address - Phone:405-841-0088
Practice Address - Fax:405-841-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200082750AMedicaid
OK=========001OtherBCBS
OK200082750AMedicaid
OK200082750AMedicaid