MEDICARE: AGILITY MEDICAL GROUP

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	:	1609016971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILITY MEDICAL GROUP

Provider Business Mailing Address
First Line	:	2236 NW 10TH ST STE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-5658
Country	:	US
Telephone Number	:	405-842-2500
Fax Number	:	405-842-2509

Provider Business Practice Location Address
First Line	:	2236 NW 10TH ST STE 105
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-5658
Country	:	US
Telephone Number	:	405-842-2500
Fax Number	:	405-842-2509

Authorized Official
Title or Position	:	OWNER/PARTNER
Name	:	MR. GREG ROBERTSON
Credential	:
Telephone Number	:	405-842-2500

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	02/26/2009

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