Healthcare Provider Details

I. General information

NPI: 1962024992
Provider Name (Legal Business Name): A&B ENGRAVING, INC DBA A&B IDENTITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 E 3RD ST
TULSA OK
74104-1816
US

IV. Provider business mailing address

2020 E 3RD ST
TULSA OK
74104-1816
US

V. Phone/Fax

Practice location:
  • Phone: 918-663-7446
  • Fax:
Mailing address:
  • Phone: 918-663-7446
  • Fax:

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: SCOTT BOGIE
Title or Position: CEO
Credential:
Phone: 918-663-7446