Healthcare Provider Details

I. General information

NPI: 1063747632
Provider Name (Legal Business Name): FORT SMITH HMA HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E RAY FINE BLVD
ROLAND OK
74954-5362
US

IV. Provider business mailing address

303 E RAY FINE BLVD
ROLAND OK
74954-5362
US

V. Phone/Fax

Practice location:
  • Phone: 918-427-9773
  • Fax: 918-427-6021
Mailing address:
  • Phone: 918-427-9773
  • Fax: 918-427-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY PARRY
Title or Position: SR. VP AND GENERAL COUNSEL
Credential: ESQ
Phone: 239-552-3458