MEDICARE: ELIZABETH HIMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator		OK

General Provider Information

NPI Number	:	1558728634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH HIMES

Provider Business Mailing Address
First Line	:	2935 E 76TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-8722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2935 E 76TH PL
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74136-8722
Country	:	US
Telephone Number	:	405-368-4662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	01/20/2016

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