MEDICARE: ECLIPSE THERAPY SOLUTION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1093008385	OTHER	OK	BCBS OF OKLAHOMA

General Provider Information

NPI Number	:	1093008385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECLIPSE THERAPY SOLUTION

Provider Business Mailing Address
First Line	:	PO BOX 268946
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8946
Country	:	US
Telephone Number	:	405-601-6767
Fax Number	:	405-601-6761

Provider Business Practice Location Address
First Line	:	3112 COOKE WAY
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-2401
Country	:	US
Telephone Number	:	405-601-6767
Fax Number	:	405-601-6761

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MR. TREVOR NUTT
Credential	:
Telephone Number	:	405-601-6767

Provider Enumeration Date	:	05/19/2011
Last Update Date	:	05/18/2012

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Directions to “ECLIPSE THERAPY SOLUTION ” Practice Location

Language	Start Address	Practice Location

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