Provider Demographics
NPI:1598885618
Name:INDEPENDENT MEDICAL PRODUCTS
Entity Type:Organization
Organization Name:INDEPENDENT MEDICAL PRODUCTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-226-8734
Mailing Address - Street 1:1702 N COMMERCE ST STE A
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1500
Mailing Address - Country:US
Mailing Address - Phone:580-226-8734
Mailing Address - Fax:580-223-5300
Practice Address - Street 1:1702 N COMMERCE ST STE A
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1500
Practice Address - Country:US
Practice Address - Phone:580-226-8734
Practice Address - Fax:580-223-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1124490001Medicare NSC