Provider Demographics
NPI:1073948824
Name:ALL SAINTS HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ALL SAINTS HOME MEDICAL LLC
Other - Org Name:ALL SAINTS CANCER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-488-6660
Mailing Address - Street 1:11212 E 48TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-5806
Mailing Address - Country:US
Mailing Address - Phone:918-556-7127
Mailing Address - Fax:918-556-7067
Practice Address - Street 1:11212 E 48TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-5806
Practice Address - Country:US
Practice Address - Phone:918-556-7127
Practice Address - Fax:918-556-7067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2-6800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2148220OtherPK
2142053OtherPK