1588646749 NPI number — HOSPICE OF MCALESTER OKLAHOMA INC.

Table of content: (NPI 1588646749)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588646749 NPI number — HOSPICE OF MCALESTER OKLAHOMA INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF MCALESTER OKLAHOMA 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:
HOSPICE OF MCALESTER
Provider Other Organization Name Type Code:
5
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:
1588646749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALESTER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74502-1333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-423-3911
Provider Business Mailing Address Fax Number:
918-423-4241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E WYANDOTTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALESTER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74501-5429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-423-3911
Provider Business Practice Location Address Fax Number:
918-423-4241
Provider Enumeration Date:
11/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PATTON
Authorized Official First Name:
BRANDY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXUCUTIVE DIRECTOR
Authorized Official Telephone Number:
918-423-3911

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4019 , 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: HO4019 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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