Provider Demographics
NPI:1629068879
Name:RUSSELL-MURRAY HOSPICE, INC.
Entity Type:Organization
Organization Name:RUSSELL-MURRAY HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-262-3088
Mailing Address - Street 1:2001 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-2107
Mailing Address - Country:US
Mailing Address - Phone:405-262-3088
Mailing Address - Fax:405-262-3082
Practice Address - Street 1:2001 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2107
Practice Address - Country:US
Practice Address - Phone:405-262-3088
Practice Address - Fax:405-262-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4005251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371510Medicare ID - Type UnspecifiedHOSPICE