Provider Demographics
NPI:1447520820
Name:PETERS AGENCY CARE MANAGEMENT LLC
Entity type:Organization
Organization Name:PETERS AGENCY CARE MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:PHILPOT
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CCM, LHCA
Authorized Official - Phone:918-775-0250
Mailing Address - Street 1:P.O. BOX 886
Mailing Address - Street 2:926 E. CHEROKEE
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955
Mailing Address - Country:US
Mailing Address - Phone:918-775-6555
Mailing Address - Fax:918-775-6587
Practice Address - Street 1:926 E. CHEROKEE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-775-6555
Practice Address - Fax:918-775-6587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETERS AGENCY CARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based