Healthcare Provider Details

I. General information

NPI: 1942350160
Provider Name (Legal Business Name): ZOMICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 S. MINGO
TULSA OK
74146
US

IV. Provider business mailing address

4125 S. MINGO
TULSA OK
74146
US

V. Phone/Fax

Practice location:
  • Phone: 918-392-4401
  • Fax: 918-392-4408
Mailing address:
  • Phone: 918-392-4401
  • Fax: 918-392-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number4211
License Number StateOK

VIII. Authorized Official

Name: VICKY J COBLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 918-392-4401