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General NPI Number Information
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NPI Number | 1528455003
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Entity Type | Organization
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Legal Business Name | MEDICAL MART, INC.
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 623 N PORTER AVE SUITE 100
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City | NORMAN
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State | OK
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Zip | 73071-6072
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Country | US
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Telephone | 405-928-4350
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Fax | 405-928-4351
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Provider Business Mailing Address
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Address Line | 623 N PORTER AVE SUITE 100
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City | NORMAN
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State | OK
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Zip | 73071-6072
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Country | US
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Telephone | 405-928-4350
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Fax | 405-928-4351
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THAYNE KEVIN BARNES
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Credential |
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Telephone | 405-928-4350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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