Provider Demographics
NPI:1811024656
Name:PORTICO HEALTH GROUP
Entity Type:Organization
Organization Name:PORTICO HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HIGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-623-2774
Mailing Address - Street 1:9308 S WINSTON WAY
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2710
Mailing Address - Country:US
Mailing Address - Phone:405-623-2774
Mailing Address - Fax:405-703-0503
Practice Address - Street 1:9308 S WINSTON WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2710
Practice Address - Country:US
Practice Address - Phone:405-623-2774
Practice Address - Fax:405-703-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based