Healthcare Provider Details

I. General information

NPI: 1780866079
Provider Name (Legal Business Name): RAPHA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 S PEORIA AVE STE 4
TULSA OK
74105-7640
US

IV. Provider business mailing address

4224 S PEORIA AVE STE 4
TULSA OK
74105-7640
US

V. Phone/Fax

Practice location:
  • Phone: 918-270-4950
  • Fax:
Mailing address:
  • Phone: 918-270-4950
  • Fax: 866-200-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL S DICKMAN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 405-684-0729