Provider Demographics
NPI:1912954751
Name:PONCA CITY HOMECARE SERVICES INC
Entity type:Organization
Organization Name:PONCA CITY HOMECARE SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1209 E PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-1746
Mailing Address - Country:US
Mailing Address - Phone:580-765-8155
Mailing Address - Fax:580-763-4549
Practice Address - Street 1:1209 E PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-1746
Practice Address - Country:US
Practice Address - Phone:580-765-8155
Practice Address - Fax:580-763-4549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PONCA CITY HOMECARE SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-27
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200083820AMedicaid
OK200083820AMedicaid
OK=========001OtherBCBS PROVIDER NUMBER
OK5717960002Medicare NSC