Provider Demographics
NPI:1841374204
Name:CROSSROADS HOSPICE OF OKLAHOMA
Entity type:Organization
Organization Name:CROSSROADS HOSPICE OF OKLAHOMA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HOME OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUXTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:918-627-6846
Mailing Address - Street 1:10810 E 45TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3818
Mailing Address - Country:US
Mailing Address - Phone:918-627-6845
Mailing Address - Fax:918-627-6856
Practice Address - Street 1:10810 E 45TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3818
Practice Address - Country:US
Practice Address - Phone:918-627-6845
Practice Address - Fax:918-627-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4053251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4053OtherSTATE LICENSE
OK37-1544Medicare ID - Type UnspecifiedMEDICARE HOSPICE PROVIDER