Provider Demographics
NPI:1013931435
Name:HOSPICE OF SOUTHWEST OKLAHOMA INC
Entity Type:Organization
Organization Name:HOSPICE OF SOUTHWEST OKLAHOMA INC
Other - Org Name:HOSPICE OF LAWTON AREA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIXON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:580-248-5885
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:1930 NW FERRIS AVENUE SUITE #5
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502
Mailing Address - Country:US
Mailing Address - Phone:580-248-5885
Mailing Address - Fax:580-355-2446
Practice Address - Street 1:1930 NW FERRIS AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-5626
Practice Address - Country:US
Practice Address - Phone:580-248-5885
Practice Address - Fax:580-355-2446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4015251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371512Medicare ID - Type Unspecified