MEDICARE: ALS MEDICAL, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	838300	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C08403722	OTHER	OK	SUBMITTER ID #

General Provider Information

NPI Number	:	1578691473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALS MEDICAL, INC.

Provider Business Mailing Address
First Line	:	10632 S MEMORIAL DR # 146
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74133-7313
Country	:	US
Telephone Number	:	800-599-0425
Fax Number	:	918-369-0179

Provider Business Practice Location Address
First Line	:	11415 S 91ST EAST AVE
Second Line	:
City	:	BIXBY
State	:	OK
Zip	:	74008-1749
Country	:	US
Telephone Number	:	800-599-0425
Fax Number	:	918-369-0179

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID R. WHEELER
Credential	:
Telephone Number	:	800-599-0425

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/01/2008

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Directions to “ALS MEDICAL, INC. ” Practice Location

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