Provider Demographics
NPI:1770655888
Name:AMERICAN HOSPICE, LLC
Entity Type:Organization
Organization Name:AMERICAN HOSPICE, LLC
Other - Org Name:MILLER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CROCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN, BA
Authorized Official - Phone:918-742-6415
Mailing Address - Street 1:6950 S UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:918-742-6415
Mailing Address - Fax:918-742-6413
Practice Address - Street 1:6950 S UTICA AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3903
Practice Address - Country:US
Practice Address - Phone:918-742-6415
Practice Address - Fax:918-742-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4163251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
371634Medicare Oscar/Certification