Provider Demographics
NPI:1548875545
Name:HOUSE CALLS DIRECT PLLC
Entity type:Organization
Organization Name:HOUSE CALLS DIRECT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN/CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DERRICO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, CNP
Authorized Official - Phone:580-512-0746
Mailing Address - Street 1:415 W GORE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-3710
Mailing Address - Country:US
Mailing Address - Phone:580-248-9966
Mailing Address - Fax:
Practice Address - Street 1:415 W GORE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3710
Practice Address - Country:US
Practice Address - Phone:580-248-9966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty