=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922863117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRIOT PROSTHETICS AND ORTHOTICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2024
-----------------------------------------------------
Last Update Date | 02/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2305 S I 35 SERVICE RD
-----------------------------------------------------
City | MOORE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73160-2775
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-703-1472
-----------------------------------------------------
Fax | 405-703-1653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1804 COMMONS CIR STE A
-----------------------------------------------------
City | YUKON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73099-9525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-577-6778
-----------------------------------------------------
Fax | 405-577-6799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE ADMINISTRATOR
-----------------------------------------------------
Name | MICHELE HUGGINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-577-6778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------