Provider Demographics
NPI:1083663223
Name:INTERIM HEALTHCARE OF TULSA, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF TULSA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-749-9933
Mailing Address - Street 1:2828 E 51ST STREET
Mailing Address - Street 2:STE 218
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105
Mailing Address - Country:US
Mailing Address - Phone:918-749-9933
Mailing Address - Fax:918-746-7824
Practice Address - Street 1:2828 E 51ST STREET
Practice Address - Street 2:STE 218
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105
Practice Address - Country:US
Practice Address - Phone:918-749-9933
Practice Address - Fax:918-747-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-06
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7014251E00000X
OK4256251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7014OtherSTATE LICENSE NUMBER
OK7014OtherSTATE LICENSE NUMBER
OK377237Medicare Oscar/Certification