Provider Demographics
NPI:1043592041
Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Entity Type:Organization
Organization Name:MERCY HOSPITAL OKLAHOMA CITY, INC.
Other - Org Name:MERCY AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENLOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-3161
Mailing Address - Street 1:530 N MONTE VISTA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4675
Mailing Address - Country:US
Mailing Address - Phone:405-282-9406
Mailing Address - Fax:
Practice Address - Street 1:530 N MONTE VISTA ST
Practice Address - Street 2:SUITE B
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4675
Practice Address - Country:US
Practice Address - Phone:405-282-9406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HEALTH CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK37-7258Medicare PIN