Organization
MIDSTATE REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TANDIE HASTINGS (PRESIDENT)
(405) 282-6285
Entity
Organization
Contact information
Practice address
114 S ASH ST, GUTHRIE, OK 73044-4908
(405) 282-2005
(405) 282-2129
Mailing address
114 S ASH ST, GUTHRIE, OK 73044-4908
(405) 282-2005
(405) 282-2129
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200055810A
—
OK
Enumeration date
07/21/2005
Last updated
05/13/2008
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