Provider Demographics
NPI:1174593834
Name:FREEDOM MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:FREEDOM MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY LYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-228-0911
Mailing Address - Street 1:1845 W RENO AVE # B
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-3217
Mailing Address - Country:US
Mailing Address - Phone:405-228-0911
Mailing Address - Fax:405-228-0942
Practice Address - Street 1:1845 W RENO AVE # B
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-3217
Practice Address - Country:US
Practice Address - Phone:405-228-0911
Practice Address - Fax:405-228-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200072370AMedicaid
OK200072370AMedicaid
OK200072370AMedicaid