Provider Demographics
NPI:1164497541
Name:PALLIATIVE HOSPICE
Entity Type:Organization
Organization Name:PALLIATIVE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-848-2277
Mailing Address - Street 1:3503 NW 63RD ST
Mailing Address - Street 2:SUITE 605
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2239
Mailing Address - Country:US
Mailing Address - Phone:405-848-2277
Mailing Address - Fax:405-848-2909
Practice Address - Street 1:3503 NW 63RD ST
Practice Address - Street 2:SUITE 605
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2239
Practice Address - Country:US
Practice Address - Phone:405-848-2277
Practice Address - Fax:405-848-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251G00000X
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371592Medicare ID - Type UnspecifiedSEMINOLE HOSPICE PROVIDER
TX451719Medicare ID - Type UnspecifiedPROVIDER NUMBER
TX451758Medicare ID - Type UnspecifiedPROVIDER NUMBER