Provider Demographics
NPI:1083789143
Name:CHARLEBOIS MEDICAL SYSTEMS
Entity Type:Organization
Organization Name:CHARLEBOIS MEDICAL SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CHARLEBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-376-2656
Mailing Address - Street 1:2019 E STATE HWY 152
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064
Mailing Address - Country:US
Mailing Address - Phone:405-376-2656
Mailing Address - Fax:405-256-0254
Practice Address - Street 1:2019 E STATE HWY 152
Practice Address - Street 2:SUITE 101
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064
Practice Address - Country:US
Practice Address - Phone:405-376-2656
Practice Address - Fax:405-256-0254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4805670001Medicare ID - Type Unspecified