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General NPI Number Information
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NPI Number | 1265970040
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Entity Type | Organization
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Legal Business Name | FENNER, INC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 2019 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-2759
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Country | US
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Telephone | 918-537-2001
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Fax | 918-537-2139
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Provider Business Mailing Address
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Address Line | 2019 W BROADWAY ST
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City | MUSKOGEE
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State | OK
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Zip | 74401-2759
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Country | US
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Telephone | 918-537-2001
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Fax | 918-537-2139
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL O FENNER
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Credential | CPO
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Telephone | 918-832-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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