Provider Demographics
NPI:1598917122
Name:AMBASSADOR PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:AMBASSADOR PHYSICIAN GROUP LLC
Other - Org Name:PHYSICIAN'S HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:682-561-1658
Mailing Address - Street 1:1067 FOCH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2919
Mailing Address - Country:US
Mailing Address - Phone:817-263-8808
Mailing Address - Fax:817-263-8811
Practice Address - Street 1:1000 W WILSHIRE BLVD
Practice Address - Street 2:SUITE 123
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7030
Practice Address - Country:US
Practice Address - Phone:405-418-2991
Practice Address - Fax:405-418-2977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMBASSADOR SENIOR MANAGEMENT GROUP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based