Provider Demographics
NPI:1265645337
Name:BRADLEY J. ROUSE
Entity Type:Organization
Organization Name:BRADLEY J. ROUSE
Other - Org Name:MEDI-SOL.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-608-4200
Mailing Address - Street 1:PO BOX 7736
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-7736
Mailing Address - Country:US
Mailing Address - Phone:405-608-4200
Mailing Address - Fax:405-608-4214
Practice Address - Street 1:14018 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1977
Practice Address - Country:US
Practice Address - Phone:405-608-4200
Practice Address - Fax:405-608-4214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies