Provider Demographics
NPI:1215365069
Name:XLHOME OKLAHOMA, INC.
Entity Type:Organization
Organization Name:XLHOME OKLAHOMA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-633-8590
Mailing Address - Street 1:351 W CAMDEN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-7912
Mailing Address - Country:US
Mailing Address - Phone:410-625-2200
Mailing Address - Fax:410-625-2244
Practice Address - Street 1:351 W CAMDEN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7912
Practice Address - Country:US
Practice Address - Phone:410-625-2200
Practice Address - Fax:410-625-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty