Healthcare Provider Details

I. General information

NPI: 1376858373
Provider Name (Legal Business Name): JUDE & JODY FURNITURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SW 29TH ST
OKLAHOMA CITY OK
73109-6746
US

IV. Provider business mailing address

509 SW 29TH ST
OKLAHOMA CITY OK
73109-6746
US

V. Phone/Fax

Practice location:
  • Phone: 405-631-1505
  • Fax: 405-631-0505
Mailing address:
  • Phone: 405-631-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: J.D. D. NORTHCUTT
Title or Position: PRESIDENT
Credential:
Phone: 405-631-1505