Healthcare Provider Details

I. General information

NPI: 1639195092
Provider Name (Legal Business Name): NIX'S MEDICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SIOUX ST
SALLISAW OK
74955-5229
US

IV. Provider business mailing address

PO BOX 940
SALLISAW OK
74955-0940
US

V. Phone/Fax

Practice location:
  • Phone: 918-775-7778
  • Fax: 918-775-7770
Mailing address:
  • Phone: 918-775-7778
  • Fax: 918-775-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. PATRICK DEAN NIX SR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 918-775-7778