Healthcare Provider Details

I. General information

NPI: 1174768774
Provider Name (Legal Business Name): TEXOMA MEDICAL SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N.W. HIGHWAY 270 STE. A
SEILING OK
73663
US

IV. Provider business mailing address

PO BOX 236
TALOGA OK
73667-0236
US

V. Phone/Fax

Practice location:
  • Phone: 580-922-4403
  • Fax: 580-922-4405
Mailing address:
  • Phone: 580-328-5208
  • Fax: 580-328-5211

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 TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number705362
License Number StateOK

VIII. Authorized Official

Name: MICAH COLE
Title or Position: PHARMACIST
Credential: PHD
Phone: 580-922-4403