Provider Demographics
NPI:1598763575
Name:AGATENO TECHNOLOGIES, LP
Entity Type:Organization
Organization Name:AGATENO TECHNOLOGIES, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM 'BILLY'
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-447-4702
Mailing Address - Street 1:2500 S. MCGEE DR
Mailing Address - Street 2:SUITE 145
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072
Mailing Address - Country:US
Mailing Address - Phone:405-447-6017
Mailing Address - Fax:405-447-6301
Practice Address - Street 1:2500 S. MCGEE DR
Practice Address - Street 2:SUITE 145
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-447-6017
Practice Address - Fax:405-447-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0107045332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4926220001Medicare NSC
492-6220-001Medicare ID - Type Unspecified