Provider Demographics
NPI:1962593301
Name:MCCORTNEY FAMILY HOSPICE, INC
Entity type:Organization
Organization Name:MCCORTNEY FAMILY HOSPICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KILLEN
Authorized Official - Last Name:MCCORTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-332-6900
Mailing Address - Street 1:117 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-5801
Mailing Address - Country:US
Mailing Address - Phone:580-332-6900
Mailing Address - Fax:580-332-3969
Practice Address - Street 1:117 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-5801
Practice Address - Country:US
Practice Address - Phone:580-332-6900
Practice Address - Fax:580-332-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4168251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371629Medicare ID - Type Unspecified