Provider Demographics
NPI:1265489488
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 OF ADA
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 1:1201 ARLINGTON
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4072
Practice Address - Country:US
Practice Address - Phone:580-436-6060
Practice Address - Fax:580-436-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23S899332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100234540FMedicaid
OK0935160004Medicare NSC