Provider Demographics
NPI:1548224348
Name:TEXOMA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:TEXOMA MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DAILY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-328-5208
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TALOGA
Mailing Address - State:OK
Mailing Address - Zip Code:73667-0236
Mailing Address - Country:US
Mailing Address - Phone:580-328-5208
Mailing Address - Fax:580-328-5211
Practice Address - Street 1:107 S BROADWAY
Practice Address - Street 2:
Practice Address - City:TALOGA
Practice Address - State:OK
Practice Address - Zip Code:73667
Practice Address - Country:US
Practice Address - Phone:580-328-5718
Practice Address - Fax:580-328-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
OK7042023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========001OtherBLUE CROSS BLUE SHIELD
1051910003Medicare ID - Type Unspecified