Provider Demographics
NPI:1144268285
Name:ODYSSEY HEALTH CARE INC.
Entity type:Organization
Organization Name:ODYSSEY HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-223-3383
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6503
Mailing Address - Country:US
Mailing Address - Phone:580-223-3383
Mailing Address - Fax:580-223-6696
Practice Address - Street 1:2 W MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6503
Practice Address - Country:US
Practice Address - Phone:580-223-3383
Practice Address - Fax:580-223-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747650CMedicaid
OK100747650CMedicaid