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General NPI Number Information
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NPI Number | 1770113813
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Entity Type | Organization
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Legal Business Name | PALLIATIVE CARE AT HEART, LLC
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Dates
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Enumeration Date | 01/16/2020
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 2703 N BROADWAY ST STE A
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City | POTEAU
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State | OK
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Zip | 74953-5554
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Country | US
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Telephone | 918-647-7008
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Fax | 918-647-7168
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-443-4154
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | NICHOLAS GACHASSIN III
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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