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General NPI Number Information
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NPI Number | 1801802699
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Entity Type | Organization
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Legal Business Name | MARBLE WORKS OF LAWTON
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 SW C AVE. SUITE 14
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City | LAWTON
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State | OK
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Zip | 73501-4600
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Country | US
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Telephone | 580-357-8664
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Fax | 580-354-9050
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Provider Business Mailing Address
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Address Line | 200 SW C AVE SUITE 14
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City | LAWTON
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State | OK
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Zip | 73501-4600
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Country | US
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Telephone | 580-357-8664
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Fax | 580-354-9050
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MIKE LEWIS
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Credential |
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Telephone | 580-357-8664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 847868
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License Number State | OK
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