Provider Demographics
NPI:1164977484
Name:DOCTORS @ HOME, INC
Entity Type:Organization
Organization Name:DOCTORS @ HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN
Authorized Official - Phone:405-200-5702
Mailing Address - Street 1:4501 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73122-2404
Mailing Address - Country:US
Mailing Address - Phone:405-354-5454
Mailing Address - Fax:405-942-1555
Practice Address - Street 1:4501 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73122-2404
Practice Address - Country:US
Practice Address - Phone:405-354-5454
Practice Address - Fax:405-942-1555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty