Provider Demographics
NPI:1487824595
Name:PHYSICIANS AT HOME, INC.
Entity Type:Organization
Organization Name:PHYSICIANS AT HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-232-0101
Mailing Address - Street 1:7 S MICKEY MANTLE DR STE 325
Mailing Address - Street 2:STE. 325
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-2436
Mailing Address - Country:US
Mailing Address - Phone:405-232-0101
Mailing Address - Fax:405-232-0102
Practice Address - Street 1:7 S MICKEY MANTLE DR
Practice Address - Street 2:STE. 325
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-2458
Practice Address - Country:US
Practice Address - Phone:405-232-0101
Practice Address - Fax:405-232-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK700077Medicare PIN
OKOK404154Medicare PIN
OKOK404411Medicare PIN
OKOK700309Medicare PIN
OKOK402485Medicare PIN
OKOKB5061Medicare PIN
OK404564Medicare PIN