Healthcare Provider Details

I. General information

NPI: 1972407138
Provider Name (Legal Business Name): ELEVANCE DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473690 E 1130 RD
MULDROW OK
74948-5661
US

IV. Provider business mailing address

473690 E 1130 RD
MULDROW OK
74948-5661
US

V. Phone/Fax

Practice location:
  • Phone: 541-318-9199
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HAMZA GHUMMAN
Title or Position: CEO
Credential:
Phone: 541-318-9199