Provider Demographics
NPI:1083608855
Name:SENIOR CARE MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:SENIOR CARE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:STUDDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-756-1749
Mailing Address - Street 1:PO BOX 473
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-0473
Mailing Address - Country:US
Mailing Address - Phone:918-756-1749
Mailing Address - Fax:918-756-1754
Practice Address - Street 1:1001 E 20TH ST
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6029
Practice Address - Country:US
Practice Address - Phone:918-756-1749
Practice Address - Fax:918-756-1754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100811500Medicaid
OK731435468-001OtherBLUE CROSS BLUE SHIELD
OK0640890001Medicare NSC