Healthcare Provider Details

I. General information

NPI: 1144268285
Provider Name (Legal Business Name): ODYSSEY HEALTH CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W MAIN ST SUITE 200
ARDMORE OK
73401-6503
US

IV. Provider business mailing address

2 W MAIN ST SUITE 200
ARDMORE OK
73401-6503
US

V. Phone/Fax

Practice location:
  • Phone: 580-223-3383
  • Fax: 580-223-6696
Mailing address:
  • Phone: 580-223-3383
  • Fax: 580-223-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT BLACKWELL
Title or Position: PRESIDENT
Credential:
Phone: 580-223-3383