Healthcare Provider Details

I. General information

NPI: 1245549567
Provider Name (Legal Business Name): PS&A CASE MANAGEMENT & PROVIDER AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 S SHERIDAN RD STE 113
TULSA OK
74145-1101
US

IV. Provider business mailing address

4528 S SHERIDAN RD STE 113
TULSA OK
74145-1140
US

V. Phone/Fax

Practice location:
  • Phone: 918-282-5363
  • Fax: 918-585-7152
Mailing address:
  • Phone: 918-282-5363
  • Fax: 918-585-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: PATRICE D. SIMPKINS
Title or Position: CEO / EXECUTIVE DIRECTOR
Credential: MHR / MRC
Phone: 918-282-5363