MEDICARE: SAUNDRA S BASEY HERRIAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		OK

General Provider Information

NPI Number	:	1427054337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAUNDRA S BASEY HERRIAGE

Provider Business Mailing Address
First Line	:	10412 CONDOR TER
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-4439
Country	:	US
Telephone Number	:	405-720-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	5806 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7735
Country	:	US
Telephone Number	:	405-752-1291
Fax Number	:	405-842-1261

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MRS. SAUNDRA SUE HERRIAGE
Credential	:
Telephone Number	:	405-752-1291

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	09/06/2023

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