Healthcare Provider Details

I. General information

NPI: 1023802014
Provider Name (Legal Business Name): VISTA DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 08/30/2025
Certification Date: 08/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N 5TH ST
PONCA CITY OK
74601-4512
US

IV. Provider business mailing address

300 N 5TH ST
PONCA CITY OK
74601-4512
US

V. Phone/Fax

Practice location:
  • Phone: 580-762-1291
  • Fax:
Mailing address:
  • Phone: 580-762-1291
  • 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: DR. SCOTT T KIRKPATRICK
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 918-808-7725