Provider Demographics
NPI:1205109030
Name:SMK OF MCALESTER INC.
Entity type:Organization
Organization Name:SMK OF MCALESTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-9285
Mailing Address - Street 1:1220 E ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-3832
Mailing Address - Country:US
Mailing Address - Phone:918-967-9285
Mailing Address - Fax:918-967-9286
Practice Address - Street 1:1220 E ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-3832
Practice Address - Country:US
Practice Address - Phone:918-967-9285
Practice Address - Fax:918-967-9286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK99-070314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-5384Medicare PIN