MEDICARE: PONCA CITY HOMECARE SERVICES 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	332B00000X	Durable Medical Equipment & Medical Supplies

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	:	1912954751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PONCA CITY HOMECARE SERVICES INC

Provider Business Mailing Address
First Line	:	1209 E PROSPECT AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1746
Country	:	US
Telephone Number	:	580-765-8155
Fax Number	:	580-763-4549

Provider Business Practice Location Address
First Line	:	1209 E PROSPECT AVE
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-1746
Country	:	US
Telephone Number	:	580-765-8155
Fax Number	:	580-763-4549

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OFFICE SUPPORT
Name	:	LAURIE HOLTSFORD
Credential	:
Telephone Number	:	615-465-7466

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	06/21/2010

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