Provider Demographics
NPI:1144329202
Name:ULTRA CARE THERAPY
Entity type:Organization
Organization Name:ULTRA CARE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTHRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-687-1451
Mailing Address - Street 1:2207 HASKELL BLVD
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74403-3513
Mailing Address - Country:US
Mailing Address - Phone:918-687-1451
Mailing Address - Fax:918-687-5220
Practice Address - Street 1:2207 HASKELL BLVD
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-3513
Practice Address - Country:US
Practice Address - Phone:918-687-1451
Practice Address - Fax:918-687-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS=========3Medicaid
OK1163350001Medicare ID - Type UnspecifiedPROVIDER NUMBER