MEDICARE: SAUNDRA S BASEY HERRIAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0962180001	OTHER	OK	CIGNA

General Provider Information

NPI Number	:	1043495096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAUNDRA S BASEY HERRIAGE

Provider Business Mailing Address
First Line	:	5806 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7735
Country	:	US
Telephone Number	:	405-752-1291
Fax Number	:	405-470-1754

Provider Business Practice Location Address
First Line	:	5806 NW 63RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-7735
Country	:	US
Telephone Number	:	405-752-1291
Fax Number	:	405-470-1754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	01/11/2008

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Directions to “ SAUNDRA S BASEY HERRIAGE ” Practice Location

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