Healthcare Provider Details

I. General information

NPI: 1205901964
Provider Name (Legal Business Name): VITAL SYSTEMS OF OKLAHOMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 E HIGHLINE LANE
MUSTANG OK
73064-5133
US

IV. Provider business mailing address

1218 E HIGHLINE LANE
MUSTANG OK
73064-5133
US

V. Phone/Fax

Practice location:
  • Phone: 405-376-9980
  • Fax: 405-376-9981
Mailing address:
  • Phone: 405-376-9980
  • Fax: 405-376-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number7470
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONI ANSON
Title or Position: BUSINESS MNGR
Credential:
Phone: 405-376-9980