1790776086 NPI number — HOSPICE CENTER OF SOUTHEASTERN OKLAHOMA, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790776086 NPI number — HOSPICE CENTER OF SOUTHEASTERN OKLAHOMA, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOSPICE CENTER OF SOUTHEASTERN 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:
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:
1790776086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1018
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANT
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74702-1018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-920-0600
Provider Business Mailing Address Fax Number:
580-920-0610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 NE LINCOLN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDABEL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74745-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-208-2273
Provider Business Practice Location Address Fax Number:
580-286-2226
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WYATT
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
580-920-0600

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  4210 , 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)





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