Basic Information
| Provider Information | |||||||||
| NPI: | 1487824595 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PHYSICIANS AT HOME, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 S MICKEY MANTLE DR STE 325 | ||||||||
| Address2: | STE. 325 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731042436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052320101 | ||||||||
| FaxNumber: | 4052320102 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 S MICKEY MANTLE DR | ||||||||
| Address2: | STE. 325 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731042458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052320101 | ||||||||
| FaxNumber: | 4052320102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | FERRIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4052320101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.