Provider Demographics
NPI:1346245735
Name:QUALITY HOME MEDICAL EQUIPMENT
Entity Type:Organization
Organization Name:QUALITY HOME MEDICAL EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:STAFFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:918-968-9226
Mailing Address - Street 1:524 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STROUD
Mailing Address - State:OK
Mailing Address - Zip Code:74079-4217
Mailing Address - Country:US
Mailing Address - Phone:918-968-9226
Mailing Address - Fax:918-968-2169
Practice Address - Street 1:947 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2837
Practice Address - Country:US
Practice Address - Phone:918-225-7463
Practice Address - Fax:918-225-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========003OtherBLUE CROSS BLUE SHIELD
OK4027250003Medicare NSC