Provider Demographics
NPI:1386883361
Name:ANTHEM HOSPICE OF OKLAHOMA CITY LLC
Entity type:Organization
Organization Name:ANTHEM HOSPICE OF OKLAHOMA CITY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-464-0717
Mailing Address - Street 1:425 W WILSHIRE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7794
Mailing Address - Country:US
Mailing Address - Phone:405-724-6687
Mailing Address - Fax:405-724-6491
Practice Address - Street 1:425 W WILSHIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7794
Practice Address - Country:US
Practice Address - Phone:405-724-6687
Practice Address - Fax:405-724-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4212251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371660OtherOKLAHOMA LICENSE
OKHO4212OtherSTATE LICENSE