MEDICARE: JUDE & JODY FURNITURE INC.

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	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1376858373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDE & JODY FURNITURE INC.

Provider Business Mailing Address
First Line	:	509 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6746
Country	:	US
Telephone Number	:	405-631-1505
Fax Number	:

Provider Business Practice Location Address
First Line	:	509 SW 29TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73109-6746
Country	:	US
Telephone Number	:	405-631-1505
Fax Number	:	405-631-0505

Authorized Official
Title or Position	:	PRESIDENT
Name	:	J.D. D. NORTHCUTT
Credential	:
Telephone Number	:	405-631-1505

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2010

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