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NPI Code Detail

MEDICARE: CROSSROADS HOSPICE OF OKLAHOMA CITY, LLC

MEDICARE: CROSSROADS HOSPICE OF OKLAHOMA CITY, 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
1207QH0002XHospice and Palliative Medicine (Family Medicine) Physician
2251G00000XCommunity Based Hospice Care Agency4142OK

General Provider Information

NPI Number : 1700826138
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSROADS HOSPICE OF OKLAHOMA CITY, LLC
Provider Business Mailing Address
First Line : 10810 E 45TH ST
Second Line : SUITE 300
City : TULSA
State : OK
Zip : 74146-3818
Country : US
Telephone Number : 918-627-6846
Fax Number : 918-627-6856
Provider Business Practice Location Address
First Line : 1301 SE 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73129-7307
Country : US
Telephone Number : 405-632-9631
Fax Number : 405-632-9624
Authorized Official
Title or Position : CFO/COO
Name : CLAYTON LEE FARMER
Credential :
Telephone Number : 918-627-6846
Provider Enumeration Date : 06/07/2006
Last Update Date : 11/14/2022

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