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General NPI Number Information
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NPI Number | 1487694816
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Entity Type | Organization
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Legal Business Name | PONCA CITY HOMECARE SERVICES INC.
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Dates
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Enumeration Date | 06/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1900 N 14TH ST
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City | PONCA CITY
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State | OK
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Zip | 74601-2035
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Country | US
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Telephone | 580-765-8155
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Fax | 580-763-4549
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Provider Business Mailing Address
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Address Line | 1209 E PROSPECT AVE
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City | PONCA CITY
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State | OK
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Zip | 74601-1746
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Country | US
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Telephone | 580-765-8155
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Fax | 580-763-4549
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Authorized Official
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Title or Position | COO
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Name | MRS. ALICE ROSEWITZ
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Credential |
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Telephone | 580-765-8155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 6-5084
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License Number State | OK
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