Provider Demographics
NPI:1235242074
Name:ROSS HOSPICE OF PONCA CITY, LLC
Entity Type:Organization
Organization Name:ROSS HOSPICE OF PONCA CITY, LLC
Other - Org Name:ELARA CARING VIII
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REGULATORY
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-234-1866
Mailing Address - Street 1:14295 MIDWAY ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001
Mailing Address - Country:US
Mailing Address - Phone:800-234-1866
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:1020 N BOOMER RD STE 1
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075
Practice Address - Country:US
Practice Address - Phone:580-765-9090
Practice Address - Fax:580-765-9117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4174251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371626Medicare UPIN
OK37-1626Medicare ID - Type UnspecifiedMEDICARE