1568453751 NPI number — HOSPICE OF OWASSO, INC

Table of content: (NPI 1568453751)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568453751 NPI number — HOSPICE OF OWASSO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE OF OWASSO, 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:
Provider Other Organization Name Type Code:
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:
1568453751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 S CEDAR ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
OWASSO
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74055-3451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-274-0333
Provider Business Mailing Address Fax Number:
918-274-0435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 S CEDAR ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
OWASSO
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74055-3451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-274-0333
Provider Business Practice Location Address Fax Number:
918-274-0435
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELSO
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
918-274-0333

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4178 , 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: 4178 . This is a "HOSPICE LICENSE NUMBER" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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