MEDICARE: PHC 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1316504392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHC HOSPICE, LLC

Provider Business Mailing Address
First Line	:	2831 NW 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7005
Country	:	US
Telephone Number	:	405-602-3295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 NW 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-7005
Country	:	US
Telephone Number	:	405-602-3295
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	BRIAN KEITH BANKS
Credential	:
Telephone Number	:	405-602-3295

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/24/2019

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