MEDICARE: PROFESSIONAL HOME CARE OF GARVIN COUNTY OKLAHOMA INC

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	251E00000X	Home Health Agency	7328	OK

General Provider Information

NPI Number	:	1518969740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HOME CARE OF GARVIN COUNTY OKLAHOMA INC

Provider Business Mailing Address
First Line	:	2510 W GRANT AVE
Second Line	:
City	:	PAULS VALLEY
State	:	OK
Zip	:	73075-9247
Country	:	US
Telephone Number	:	405-238-7563
Fax Number	:	405-238-5990

Provider Business Practice Location Address
First Line	:	2510 W GRANT AVE
Second Line	:
City	:	PAULS VALLEY
State	:	OK
Zip	:	73075-9247
Country	:	US
Telephone Number	:	405-238-7563
Fax Number	:	405-238-5990

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	MR. TONY HOVIS
Credential	:
Telephone Number	:	405-238-7563

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	09/23/2011

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