Healthcare Provider Details

I. General information

NPI: 1982767950
Provider Name (Legal Business Name): OKLAHOMA MEDICAL SERVICES & SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 E 91ST ST STE 180
TULSA OK
74133-6047
US

IV. Provider business mailing address

7614 E 91ST ST STE 180
TULSA OK
74133-6047
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-9994
  • Fax: 918-494-9745
Mailing address:
  • Phone: 918-494-9994
  • Fax: 918-494-9745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A TRAUB
Title or Position: OWNER
Credential: M.D.
Phone: 918-494-9994