Provider Demographics
NPI:1982652194
Name:MIDWEST HMA HOME HEALTH, LLC
Entity Type:Organization
Organization Name:MIDWEST HMA HOME HEALTH, LLC
Other - Org Name:MIDWEST REGIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:1117 S DOUGLAS BLVD
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5262
Mailing Address - Country:US
Mailing Address - Phone:405-736-6925
Mailing Address - Fax:405-736-0719
Practice Address - Street 1:1117 S DOUGLAS BLVD
Practice Address - Street 2:SUITES A & B
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5262
Practice Address - Country:US
Practice Address - Phone:405-736-6925
Practice Address - Fax:405-736-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7200251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200027820AMedicaid
OK200027820AMedicaid