=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528480811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHYSICIAN HOUSECALLS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 09/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W HEFNER RD
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73114-6631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-896-8058
-----------------------------------------------------
Fax | 855-223-1999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 UNIVERSITY PLZ STE 204
-----------------------------------------------------
City | HACKENSACK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07601-6211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-295-8223
-----------------------------------------------------
Fax | 855-223-1999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MANAGING MEMBER
-----------------------------------------------------
Name | MR. HENRY ROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-896-8058
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------