Provider Demographics
NPI:1538118161
Name:FENNER INC
Entity Type:Organization
Organization Name:FENNER INC
Other - Org Name:SPECIALTY PROSTHETICS AND ORTHOTICS OF TULSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:O'BRIEN
Authorized Official - Last Name:FENNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPO
Authorized Official - Phone:918-832-7768
Mailing Address - Street 1:10338 E 21ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74129-1606
Mailing Address - Country:US
Mailing Address - Phone:918-832-7768
Mailing Address - Fax:918-834-0759
Practice Address - Street 1:10338 E 21ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1606
Practice Address - Country:US
Practice Address - Phone:918-832-7768
Practice Address - Fax:918-834-0759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO 13335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5705420001Medicare NSC