Healthcare Provider Details

I. General information

NPI: 1124639075
Provider Name (Legal Business Name): OSTOMY 2-1-1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 VERA PL
MCLOUD OK
74851-9374
US

IV. Provider business mailing address

60 VERA PL
MCLOUD OK
74851-9374
US

V. Phone/Fax

Practice location:
  • Phone: 405-243-8001
  • Fax: 888-203-6995
Mailing address:
  • Phone: 405-243-8001
  • Fax: 888-203-6995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: DEBI K FOX
Title or Position: EXECUTIVE DIRECTOR
Credential: OMS TRAINED
Phone: 405-243-8001