Organization
INDIAN TERRITORY HOME HEALTH AND HOSPICE INC.
Active
Other names
Tishomingo Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TIM PAUL WIGINGTON (OWNER, ADMINISTRATOR)
(580) 371-2394
Entity
Organization
Contact information
Practice address
512 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-2394
(580) 371-2638
Mailing address
PO BOX 176, TISHOMINGO, OK 73460-0176
(580) 371-2394
(580) 371-2638
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
37D0472003
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100262450D
—
OK
01
—
730796180003
BC/BS
OK
Enumeration date
09/20/2006
Last updated
05/07/2008
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