Provider Demographics
NPI:1578529111
Name:PERSONAL TOUCH OF WALTERS, OKLAHOMA, INC.
Entity Type:Organization
Organization Name:PERSONAL TOUCH OF WALTERS, OKLAHOMA, INC.
Other - Org Name:PERSONAL TOUCH HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:GLINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-875-3702
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:WALTERS
Mailing Address - State:OK
Mailing Address - Zip Code:73572
Mailing Address - Country:US
Mailing Address - Phone:580-875-3702
Mailing Address - Fax:580-875-3647
Practice Address - Street 1:230 E MISSOURI
Practice Address - Street 2:
Practice Address - City:WALTERS
Practice Address - State:OK
Practice Address - Zip Code:73572
Practice Address - Country:US
Practice Address - Phone:580-875-3702
Practice Address - Fax:580-875-3647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-22
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7740251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100261070AMedicaid
377653Medicare Oscar/Certification
OK100261070AMedicaid