Healthcare Provider Details

I. General information

NPI: 1568797876
Provider Name (Legal Business Name): 180 MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 LINCOLN AVE UNIT #5
WEST CHESTER PA
19380-4474
US

IV. Provider business mailing address

8516 NW EXPRESSWAY
OKLAHOMA CITY OK
73162-6010
US

V. Phone/Fax

Practice location:
  • Phone: 484-472-6072
  • Fax: 888-718-0633
Mailing address:
  • Phone: 877-688-2729
  • Fax: 888-718-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number6000008210
License Number StatePA

VIII. Authorized Official

Name: MR. JEFFERY B HENDRIX
Title or Position: CFO
Credential:
Phone: 405-443-2985