MEDICARE: MISSION HOSPICE LLC

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	3336S0011X	Specialty Pharmacy	15156	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3721013	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1306867379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSION HOSPICE LLC

Provider Business Mailing Address
First Line	:	1608 NW EXPRESSWAY ST
Second Line	:	STE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1402
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1608 NW EXPRESSWAY ST
Second Line	:	STE B
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-1402
Country	:	US
Telephone Number	:	405-841-3841
Fax Number	:	405-841-3843

Authorized Official
Title or Position	:	PHARMACIST MANAGER
Name	:	DEANNE JACOBS
Credential	:	DPH
Telephone Number	:	405-841-3841

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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Directions to “MISSION HOSPICE LLC ” Practice Location

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