Provider Demographics
NPI:1598792491
Name:BOK MEDICAL SERVICE
Entity Type:Organization
Organization Name:BOK MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BASIL
Authorized Official - Middle Name:OBASI
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-784-1857
Mailing Address - Street 1:211 WEST GANSON ST,
Mailing Address - Street 2:STE.110
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-784-1857
Mailing Address - Fax:517-784-4138
Practice Address - Street 1:211 W GANSON ST
Practice Address - Street 2:STE.110
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1262
Practice Address - Country:US
Practice Address - Phone:517-784-1857
Practice Address - Fax:517-784-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MID =========OtherSALE TAX