Provider Demographics
NPI:1093879025
Name:ALL SAINTS HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ALL SAINTS HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-494-8497
Mailing Address - Street 1:6585 S YALE AVE
Mailing Address - Street 2:STE 345
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8384
Mailing Address - Country:US
Mailing Address - Phone:918-502-2727
Mailing Address - Fax:918-502-2720
Practice Address - Street 1:6585 S YALE AVE
Practice Address - Street 2:STE 435
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8384
Practice Address - Country:US
Practice Address - Phone:918-502-2727
Practice Address - Fax:918-502-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100807350AMedicaid
OK18003OtherMEDICARE ID SUBMITTER
OK18003OtherMEDICARE ID SUBMITTER