=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902832488
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASBURY MEDICAL SUPPLY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2006
-----------------------------------------------------
Last Update Date | 06/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3401 N MAY AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-6904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-858-0097
-----------------------------------------------------
Fax | 405-858-0119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3401 N MAY AVE
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-6904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-858-0097
-----------------------------------------------------
Fax | 405-858-0119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT / OWNER
-----------------------------------------------------
Name | STEVE ASBURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-858-0097
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------