Healthcare Provider Details

I. General information

NPI: 1962892224
Provider Name (Legal Business Name): HOMESTEAD ALLERGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N MAIN ST
BRISTOW OK
74010-2408
US

IV. Provider business mailing address

PO BOX 839
BRISTOW OK
74010-0839
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-6533
  • Fax: 918-367-6544
Mailing address:
  • Phone: 918-367-6533
  • Fax: 918-367-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: RICHARD W SCHAFER
Title or Position: OWNER
Credential: DO
Phone: 918-960-1751