Healthcare Provider Details

I. General information

NPI: 1619252434
Provider Name (Legal Business Name): CMN ENTERPRISES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 05/16/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W MAIN STREET
ADA OK
74820
US

IV. Provider business mailing address

709 W MAIN STREET
ADA OK
74820
US

V. Phone/Fax

Practice location:
  • Phone: 580-332-7275
  • Fax: 580-332-4838
Mailing address:
  • Phone: 580-332-7275
  • Fax: 580-332-4838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number51
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number51
License Number StateOK

VIII. Authorized Official

Name: CHARLES M NORDAN
Title or Position: MANAGER
Credential: LPO
Phone: 580-332-7275