MEDICARE: PROFESSIONAL HOME HOSPICE OF MUSKOGEE, 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	251G00000X	Community Based Hospice Care Agency	4155	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598736712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL HOME HOSPICE OF MUSKOGEE, INC.

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8470

Provider Business Practice Location Address
First Line	:	4815 S HARVARD AVE STE 300A
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-3055
Country	:	US
Telephone Number	:	918-683-9400
Fax Number	:	918-351-7232

Authorized Official
Title or Position	:	DIR LICENSE & REGULATORY COMPLIANCE
Name	:	ANGEL STANSBURY
Credential	:
Telephone Number	:	337-344-2141

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	02/06/2026

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