=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689229692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEASONS HOSPICE OF MUSKOGEE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2019
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1903 N MAIN ST
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-910-5018
-----------------------------------------------------
Fax | 918-910-5038
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1903 N MAIN ST
-----------------------------------------------------
City | MUSKOGEE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74401-4130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-910-5018
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TIMOTHY WINTERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 918-492-6440
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------