Provider Demographics
NPI:1386625390
Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC
Entity type:Organization
Organization Name:BAPTIST VILLAGE RETIREMENT COMMUNITIES OF OKLAHOMA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-942-3000
Mailing Address - Street 1:3800 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6639
Mailing Address - Country:US
Mailing Address - Phone:405-942-3800
Mailing Address - Fax:405-942-0018
Practice Address - Street 1:208 E 5TH AVE
Practice Address - Street 2:SUITES F, G, H
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-3453
Practice Address - Country:US
Practice Address - Phone:918-274-4310
Practice Address - Fax:918-274-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100810750AMedicaid
OK0904200001Medicare NSC