Healthcare Provider Details

I. General information

NPI: 1396750873
Provider Name (Legal Business Name): SHERRILL'S RESPIRATORY & DIABETIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MAIN ST
BROKEN BOW OK
74728-3973
US

IV. Provider business mailing address

PO BOX 1247
BROKEN BOW OK
74728-1247
US

V. Phone/Fax

Practice location:
  • Phone: 580-286-5745
  • Fax: 580-286-5742
Mailing address:
  • Phone: 580-286-5745
  • Fax: 580-286-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number3634
License Number StateOK

VIII. Authorized Official

Name: WALT T SAIN
Title or Position: OWNER
Credential:
Phone: 580-286-5745