Provider Demographics
NPI:1871693697
Name:MEDICAL PARK HOMECARE INC
Entity type:Organization
Organization Name:MEDICAL PARK HOMECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPD
Authorized Official - Phone:918-335-6688
Mailing Address - Street 1:139 SE KATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-2316
Mailing Address - Country:US
Mailing Address - Phone:918-335-6688
Mailing Address - Fax:918-335-9787
Practice Address - Street 1:139 SE KATHERINE AVE
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-2316
Practice Address - Country:US
Practice Address - Phone:918-335-6688
Practice Address - Fax:918-335-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9-D-777332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4501400001Medicare ID - Type Unspecified