MEDICARE: MEDICAL REGIONAL SPECIALIST SURGICAL PRODUCTS

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

General Provider Information

NPI Number	:	1154510873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL REGIONAL SPECIALIST SURGICAL PRODUCTS

Provider Business Mailing Address
First Line	:	1720 COVENTRY LN
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73120-1004
Country	:	US
Telephone Number	:	405-314-3058
Fax Number	:	405-562-1975

Provider Business Practice Location Address
First Line	:	1720 COVENTRY LN
Second Line	:
City	:	NICHOLS HILLS
State	:	OK
Zip	:	73120-1004
Country	:	US
Telephone Number	:	405-314-3058
Fax Number	:	405-562-1975

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MS. REAGAN L BRATCHER
Credential	:
Telephone Number	:	405-664-2642

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	05/20/2009

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