MEDICARE: TIM CARLTON PROSTHETICS 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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1679568125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM CARLTON PROSTHETICS INC.

Provider Business Mailing Address
First Line	:	9414 WESTGATE RD
Second Line	:	SUITE B.
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6245
Country	:	US
Telephone Number	:	405-721-7570
Fax Number	:	405-721-7599

Provider Business Practice Location Address
First Line	:	9414 WESTGATE RD
Second Line	:	SUITE B.
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6245
Country	:	US
Telephone Number	:	405-721-7570
Fax Number	:	405-721-7599

Authorized Official
Title or Position	:	OWNER / PROSTHETIST
Name	:	MR. TIMOTHY RAY CARLTON
Credential	:	C.P. L.P.
Telephone Number	:	405-721-7570

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	08/22/2020

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