=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487979696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S2L HOLDING, GP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2010
-----------------------------------------------------
Last Update Date | 03/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6020 W PARKER RD SUITE 200
-----------------------------------------------------
City | PLANO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75093-8171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-608-5045
-----------------------------------------------------
Fax | 972-608-5043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 E 124TH ST S
-----------------------------------------------------
City | JENKS
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74037-4971
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-633-3006
-----------------------------------------------------
Fax | 918-298-6338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGING PARTNER
-----------------------------------------------------
Name | MRS. SUSAN MICHELLE ARMSTRONG
-----------------------------------------------------
Credential | OPA, CO
-----------------------------------------------------
Telephone | 918-633-3006
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1000122
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------