Basic Information
| Provider Information | |||||||||
| NPI: | 1386667111 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MAYES COUNTY HMA HOME HEALTH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTEGRIS HOSPICE OF MAYES COUNTY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 N BAILEY ST | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743614201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188251600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1025 NE 1ST ST | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743614003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188251600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 12/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | CLIFTON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VICE PRESIDENT/GENERAL COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 2395983131 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 4035 | OK | Y | Agencies | Hospice Care, Community Based |
No ID Information.