Healthcare Provider Details

I. General information

NPI: 1255048526
Provider Name (Legal Business Name): TEXOMA MEDICAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 11/04/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 OKLAHOMA AVE
WOODWARD OK
73801-4661
US

IV. Provider business mailing address

PO BOX 236
TALOGA OK
73667-0236
US

V. Phone/Fax

Practice location:
  • Phone: 580-256-5586
  • Fax: 580-256-7574
Mailing address:
  • Phone: 580-328-5208
  • Fax: 580-328-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBIN JUSTICE
Title or Position: CORPORATE OFFICE MANAGER
Credential:
Phone: 580-328-5208