Provider Demographics
NPI:1275987422
Name:INDEPENDENCE MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:INDEPENDENCE MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GABRIEL
Authorized Official - Last Name:CHODRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-314-6072
Mailing Address - Street 1:10812 N COUNCIL RD
Mailing Address - Street 2:APARTMENT 8
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4384
Mailing Address - Country:US
Mailing Address - Phone:405-314-6072
Mailing Address - Fax:
Practice Address - Street 1:10812 N COUNCIL RD
Practice Address - Street 2:APARTMENT 8
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-4384
Practice Address - Country:US
Practice Address - Phone:405-314-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies