Provider Demographics
NPI:1114974383
Name:MEDICAL CENTER PHARMACY OF DURANT INC
Entity Type:Organization
Organization Name:MEDICAL CENTER PHARMACY OF DURANT INC
Other - Org Name:ADVANCED CARE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:W
Authorized Official - Last Name:SEAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-924-7425
Mailing Address - Street 1:1026 RADIO RD
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2991
Mailing Address - Country:US
Mailing Address - Phone:580-924-2626
Mailing Address - Fax:580-924-5171
Practice Address - Street 1:908 N ROCKFORD RD
Practice Address - Street 2:SUITE J
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2241
Practice Address - Country:US
Practice Address - Phone:580-223-6417
Practice Address - Fax:580-223-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12-S-969332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234540EMedicaid
OK0935160006Medicare NSC