Healthcare Provider Details

I. General information

NPI: 1417255605
Provider Name (Legal Business Name): TEXOMA MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1289 N AIR DEPOT BLVD
MIDWEST CITY OK
73110-3333
US

IV. Provider business mailing address

BOX 236
TALOGA OK
73667-0236
US

V. Phone/Fax

Practice location:
  • Phone: 405-741-5666
  • Fax: 405-741-1053
Mailing address:
  • Phone: 580-328-5208
  • Fax: 580-328-5211

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateOK

VIII. Authorized Official

Name: ROBIN JUSTICE
Title or Position: CORPORATE OFFICE MANAGER
Credential:
Phone: 580-328-5208