Healthcare Provider Details

I. General information

NPI: 1295867315
Provider Name (Legal Business Name): OKLAHOMA ORTHOPEDIC SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 BOBCAT CIR
EDMOND OK
73034-5836
US

IV. Provider business mailing address

1533 BOBCAT CIR
EDMOND OK
73034-5836
US

V. Phone/Fax

Practice location:
  • Phone: 405-314-3058
  • Fax: 800-401-2070
Mailing address:
  • Phone: 405-314-3058
  • Fax: 800-401-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: CHRIS BRATCHER
Title or Position: MEMBER
Credential:
Phone: 405-314-3058