Healthcare Provider Details

I. General information

NPI: 1609405950
Provider Name (Legal Business Name): ALPINE MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 N MAIN ST
MUSKOGEE OK
74401-4451
US

IV. Provider business mailing address

1601 N MAIN ST
MUSKOGEE OK
74401-4451
US

V. Phone/Fax

Practice location:
  • Phone: 918-682-7773
  • Fax: 918-775-4654
Mailing address:
  • Phone: 918-682-7773
  • Fax: 918-775-4654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY NICOLE KETCHAM
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 918-682-7773