Provider Demographics
NPI:1942287339
Name:MDR HEALTH GROUP LLC
Entity type:Organization
Organization Name:MDR HEALTH GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:580-298-9932
Mailing Address - Street 1:1637 S GEORGE NIGH EXPY STE A2
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-7424
Mailing Address - Country:US
Mailing Address - Phone:918-302-3797
Mailing Address - Fax:918-420-5249
Practice Address - Street 1:1637 S GEORGE NIGH EXPY STE A2
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-7424
Practice Address - Country:US
Practice Address - Phone:918-682-4194
Practice Address - Fax:918-682-4088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDR HEALTH GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-27
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7809251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7809OtherHOME CARE AGENCY LICENSE
OK7809OtherHOME CARE AGENCY LICENSE