MEDICARE: DEACONESS PHYSICIAN SERVICES LLC

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

General Provider Information

NPI Number	:	1497926281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS PHYSICIAN SERVICES LLC

Provider Business Mailing Address
First Line	:	7100 COMMERCE WAY
Second Line	:	SUITE 180
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2829
Country	:	US
Telephone Number	:	615-465-7000
Fax Number	:	615-465-3007

Provider Business Practice Location Address
First Line	:	5401 N PORTLAND AVE
Second Line	:	SUITE 390
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-2121
Country	:	US
Telephone Number	:	405-943-6200
Fax Number	:	405-943-0080

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	DEBBIE T BREWER
Credential	:
Telephone Number	:	615-465-7626

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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Directions to “DEACONESS PHYSICIAN SERVICES LLC ” Practice Location

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