Provider Demographics
NPI:1386667111
Name:MAYES COUNTY HMA HOME HEALTH LLC
Entity Type:Organization
Organization Name:MAYES COUNTY HMA HOME HEALTH LLC
Other - Org Name:INTEGRIS HOSPICE OF MAYES COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE PRESIDENT/GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:111 N BAILEY ST
Mailing Address - Street 2:
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74361-4201
Mailing Address - Country:US
Mailing Address - Phone:918-825-1600
Mailing Address - Fax:
Practice Address - Street 1:1025 NE 1ST ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-4003
Practice Address - Country:US
Practice Address - Phone:918-825-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4035251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371534Medicare Oscar/Certification