MEDICARE: MUSCOGEE (CREEK) NATION DME, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	332BN1400X	Nursing Facility Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	332BD1200X	Dialysis Equipment & Supplies (DME)
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	332B00000X	Durable Medical Equipment & Medical Supplies	OK

General Provider Information

NPI Number	:	1225467426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSCOGEE (CREEK) NATION DME, LLC

Provider Business Mailing Address
First Line	:	PO BOX 1256
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-1256
Country	:	US
Telephone Number	:	918-756-9279
Fax Number	:	918-756-2656

Provider Business Practice Location Address
First Line	:	1180 S BELMONT AVE
Second Line	:
City	:	OKMULGEE
State	:	OK
Zip	:	74447-6308
Country	:	US
Telephone Number	:	918-756-9279
Fax Number	:	918-756-2656

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	PAULA K EDMONDS
Credential	:
Telephone Number	:	918-756-9279

Provider Enumeration Date	:	11/07/2013
Last Update Date	:	04/26/2016

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