Provider Demographics
NPI:1295867315
Name:OKLAHOMA ORTHOPEDIC SUPPLY LLC
Entity Type:Organization
Organization Name:OKLAHOMA ORTHOPEDIC SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-314-3058
Mailing Address - Street 1:1533 BOBCAT CIR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5836
Mailing Address - Country:US
Mailing Address - Phone:405-314-3058
Mailing Address - Fax:800-401-2070
Practice Address - Street 1:1533 BOBCAT CIR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5836
Practice Address - Country:US
Practice Address - Phone:405-314-3058
Practice Address - Fax:800-401-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment