MEDICARE: LOIS M CHAPPELL-BOSOMFRIEND

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		OK

General Provider Information

NPI Number	:	1770580599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOIS M CHAPPELL-BOSOMFRIEND

Provider Business Mailing Address
First Line	:	5221 SE 12TH ST
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4505
Country	:	US
Telephone Number	:	405-677-3907
Fax Number	:	405-677-4886

Provider Business Practice Location Address
First Line	:	5221 SE 12TH ST
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4505
Country	:	US
Telephone Number	:	405-677-3907
Fax Number	:	405-677-4886

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. LOIS M CHAPPELL
Credential	:	CMF
Telephone Number	:	405-677-3907

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/31/2012

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