Healthcare Provider Details

I. General information

NPI: 1700012614
Provider Name (Legal Business Name): LITHO OF AMERICA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 05/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 E. I-240 BUSINESS PARK
OKLAHOMA CITY OK
73135
US

IV. Provider business mailing address

3637 E. I-240 BUSINESS PARK
OKLAHOMA CITY OK
73135
US

V. Phone/Fax

Practice location:
  • Phone: 800-475-4661
  • Fax: 877-769-2350
Mailing address:
  • Phone: 800-475-4661
  • Fax: 877-769-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QL0400X
TaxonomyLithotripsy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY W. MCELRATH
Title or Position: DIRECTOR OF MEDICAL OPERATIONS
Credential:
Phone: 405-826-4005