MEDICARE: ABIDE MEDICAL 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	:	1700194701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABIDE MEDICAL LLC

Provider Business Mailing Address
First Line	:	1920 NW 38TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2823
Country	:	US
Telephone Number	:	405-314-1049
Fax Number	:

Provider Business Practice Location Address
First Line	:	1920 NW 38TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2823
Country	:	US
Telephone Number	:	405-314-1049
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. LARRY DARNELL FUSTON JR.
Credential	:
Telephone Number	:	405-314-1049

Provider Enumeration Date	:	09/24/2010
Last Update Date	:	09/24/2010

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Directions to “ABIDE MEDICAL LLC ” Practice Location

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