Provider Demographics
NPI:1598754004
Name:PROCTOR ENTERPRISES, INC
Entity type:Organization
Organization Name:PROCTOR ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:580-757-2517
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:703 LEE
Mailing Address - City:RYAN
Mailing Address - State:OK
Mailing Address - Zip Code:73565-0429
Mailing Address - Country:US
Mailing Address - Phone:580-757-2517
Mailing Address - Fax:580-757-2823
Practice Address - Street 1:703 E LEE
Practice Address - Street 2:
Practice Address - City:RYAN
Practice Address - State:OK
Practice Address - Zip Code:73565
Practice Address - Country:US
Practice Address - Phone:580-757-2517
Practice Address - Fax:580-757-2823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK375203Medicare ID - Type UnspecifiedMEDICARE NUMBER