Healthcare Provider Details

I. General information

NPI: 1841785888
Provider Name (Legal Business Name): 180 MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5324 W RENO AVE STE A
OKLAHOMA CITY OK
73127-6359
US

IV. Provider business mailing address

8516 NW EXPRESSWAY
OKLAHOMA CITY OK
73162-6010
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-7707
  • Fax: 888-718-0633
Mailing address:
  • Phone: 405-702-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEFFERY B HENDRIX
Title or Position: CFO
Credential:
Phone: 405-443-2985