MEDICARE: CHANDLER OUTREACH MEDICAL CENTER, 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	:	1992892228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANDLER OUTREACH MEDICAL CENTER, LLC

Provider Business Mailing Address
First Line	:	PO BOX 108810
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-8810
Country	:	US
Telephone Number	:	405-608-1200
Fax Number	:	405-608-1250

Provider Business Practice Location Address
First Line	:	1206 MANVEL AVE
Second Line	:	STE C
City	:	CHANDLER
State	:	OK
Zip	:	74834-4401
Country	:	US
Telephone Number	:	405-258-5252
Fax Number	:	405-258-5552

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KRISTIN SELLS
Credential	:	P.A.
Telephone Number	:	405-258-5252

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/22/2020

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