Healthcare Provider Details

I. General information

NPI: 1902221492
Provider Name (Legal Business Name): HOUSECALLS TRANSITIONAL CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 S PROSPECT
OKLAHOMA CITY OK
73129
US

IV. Provider business mailing address

4311 S PROSPECT
OKLAHOMA CITY OK
73129
US

V. Phone/Fax

Practice location:
  • Phone: 405-409-6277
  • Fax:
Mailing address:
  • Phone: 405-409-6277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNY WALTER BAKER
Title or Position: CEO
Credential:
Phone: 405-409-6277