Healthcare Provider Details

I. General information

NPI: 1124076708
Provider Name (Legal Business Name): AMEDISYS QUALITY OKLAHOMA, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 S MUSKOGEE AVE SUITE 900
TAHLEQUAH OK
74464-5543
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 918-207-0108
  • Fax: 918-458-1749
Mailing address:
  • Phone: 225-292-2031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number7020
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100261090A
Identifier TypeMEDICAID
Identifier StateOK
Identifier Issuer

VIII. Authorized Official

Name: MR. WILLIAM BORNE
Title or Position: CEO
Credential:
Phone: 225-292-2031