Provider Demographics
NPI:1306898440
Name:SOTTO INTERNATIONAL, INC.
Entity type:Organization
Organization Name:SOTTO INTERNATIONAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-894-3487
Mailing Address - Street 1:5314 S YALE AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-6256
Mailing Address - Country:US
Mailing Address - Phone:918-894-3487
Mailing Address - Fax:918-712-9880
Practice Address - Street 1:5604 SUMMERHILL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4650
Practice Address - Country:US
Practice Address - Phone:903-255-0430
Practice Address - Fax:903-255-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009271251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001012826Medicaid
TX451785Medicare Oscar/Certification