Provider Demographics
NPI:1245428044
Name:FIRST CENTURY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:FIRST CENTURY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEBOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-879-3877
Mailing Address - Street 1:5801 N MAY AVE
Mailing Address - Street 2:SUITE101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4236
Mailing Address - Country:US
Mailing Address - Phone:405-879-3877
Mailing Address - Fax:405-879-0039
Practice Address - Street 1:5801 N MAY AVE
Practice Address - Street 2:SUITE101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4236
Practice Address - Country:US
Practice Address - Phone:405-879-3877
Practice Address - Fax:405-879-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6090040001Medicare NSC