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Organization
TOWN OF VICI
Active
Organization
TOWN OF VICI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL AARON BOONE B.S. BUSINESS ADMIN. (ADMINISTRATOR)
(580) 995-4216
Entity
Organization
Contact information
Practice address
619 SPECK, VICI, OK 73859-0119
(580) 995-4216
(580) 995-4237
Mailing address
619 SPECK, PO BOX 119, VICI, OK 73859-0119
(580) 995-4216
(580) 995-4237
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH2202-2202
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10077838A
—
OK
Enumeration date
10/28/2005
Last updated
06/17/2011
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