Healthcare Provider Details

I. General information

NPI: 1225467426
Provider Name (Legal Business Name): MUSCOGEE (CREEK) NATION DME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2013
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 S BELMONT AVE
OKMULGEE OK
74447-6308
US

IV. Provider business mailing address

PO BOX 1256
OKMULGEE OK
74447-1256
US

V. Phone/Fax

Practice location:
  • Phone: 918-756-9279
  • Fax: 918-756-2656
Mailing address:
  • Phone: 918-756-9279
  • Fax: 918-756-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOK

VIII. Authorized Official

Name: PAULA K EDMONDS
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-756-9279