MEDICARE: HOUSECALLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1063905354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSECALLS

Provider Business Mailing Address
First Line	:	4413 S LEE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-3527
Country	:	US
Telephone Number	:	405-245-1416
Fax Number	:	405-265-5230

Provider Business Practice Location Address
First Line	:	4413 S LEE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109
Country	:	US
Telephone Number	:	405-245-1416
Fax Number	:	405-265-5230

Authorized Official
Title or Position	:	ARNP
Name	:	VAN NGO
Credential	:	ARNP
Telephone Number	:	405-601-9191

Provider Enumeration Date	:	06/11/2018
Last Update Date	:	08/20/2018

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Directions to “HOUSECALLS ” Practice Location

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