Healthcare Provider Details

I. General information

NPI: 1982757217
Provider Name (Legal Business Name): MMS OKLAHOMA CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W WILSHIRE BLVD STE A
OKLAHOMA CITY OK
73116-7702
US

IV. Provider business mailing address

415 W WILSHIRE BLVD STE A
OKLAHOMA CITY OK
73116-7702
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-5272
  • Fax: 405-840-5274
Mailing address:
  • Phone: 405-840-5272
  • Fax: 405-840-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1-S-802
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RICHARD CUDD
Title or Position: OWNER
Credential:
Phone: 405-763-8222