Provider Demographics
NPI:1962892224
Name:HOMESTEAD ALLERGY LLC
Entity type:Organization
Organization Name:HOMESTEAD ALLERGY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-960-1751
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-0839
Mailing Address - Country:US
Mailing Address - Phone:918-367-6533
Mailing Address - Fax:918-367-6544
Practice Address - Street 1:222 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2408
Practice Address - Country:US
Practice Address - Phone:918-367-6533
Practice Address - Fax:918-367-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty