Provider Demographics
NPI:1154510873
Name:MEDICAL REGIONAL SPECIALIST SURGICAL PRODUCTS
Entity Type:Organization
Organization Name:MEDICAL REGIONAL SPECIALIST SURGICAL PRODUCTS
Other - Org Name:MRS SURGICAL PRODUCTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-664-2642
Mailing Address - Street 1:1720 COVENTRY LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLS HILLS
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1004
Mailing Address - Country:US
Mailing Address - Phone:405-314-3058
Mailing Address - Fax:405-562-1975
Practice Address - Street 1:1720 COVENTRY LN
Practice Address - Street 2:
Practice Address - City:NICHOLS HILLS
Practice Address - State:OK
Practice Address - Zip Code:73120-1004
Practice Address - Country:US
Practice Address - Phone:405-314-3058
Practice Address - Fax:405-562-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies