1437256831 NPI number — INDIAN TERRITORY HOME HEALTH AND HOSPICE INC.

Table of content: (NPI 1437256831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437256831 NPI number — INDIAN TERRITORY HOME HEALTH AND HOSPICE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDIAN TERRITORY HOME HEALTH AND HOSPICE INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TISHOMINGO FAMILY MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437256831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 176
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TISHOMINGO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73460-0176
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-371-2394
Provider Business Mailing Address Fax Number:
580-371-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 E 24TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TISHOMINGO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73460-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-371-2394
Provider Business Practice Location Address Fax Number:
580-371-2638
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIGINGTON
Authorized Official First Name:
TIM
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER, ADMINISTRATOR
Authorized Official Telephone Number:
580-371-2394

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  37D0472003 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 730796180003 . This is a "BC/BS" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 100262450D , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com