Provider Demographics
NPI:1578691473
Name:ALS MEDICAL, INC.
Entity Type:Organization
Organization Name:ALS MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-599-0425
Mailing Address - Street 1:10632 S MEMORIAL DR # 146
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-7313
Mailing Address - Country:US
Mailing Address - Phone:800-599-0425
Mailing Address - Fax:918-369-0179
Practice Address - Street 1:11415 S 91ST EAST AVE
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-1749
Practice Address - Country:US
Practice Address - Phone:800-599-0425
Practice Address - Fax:918-369-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK838300332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC08403722OtherSUBMITTER ID #
OK0918170001Medicare ID - Type UnspecifiedPROVIDER NUMBER