180 MEDICAL INC

Provider Demographics

• NPI: 1639160708
• Name: 180 MEDICAL INC
• Entity Type: Organization
• Organization Name: 180 MEDICAL INC
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: JEFFERY
• Authorized Official - Middle Name: B
• Authorized Official - Last Name: HENDRIX
• Authorized Official - Phone: 405-443-2985
• Mailing Address - Street 1: 8516 NW EXPRESSWAY
• Mailing Address - City: OKLAHOMA CITY
• Mailing Address - State: OK
• Mailing Address - Zip Code: 73162-6010
• Mailing Address - Country: US
• Mailing Address - Phone: 877-688-2729
• Mailing Address - Fax: 888-718-0633
• Practice Address - Street 1: 8516 NW EXPRESSWAY
• Practice Address - City: OKLAHOMA CITY
• Practice Address - State: OK
• Practice Address - Zip Code: 73162-6010
• Practice Address - Country: US
• Practice Address - Phone: 877-688-2729
• Practice Address - Fax: 888-718-0633
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-10-28
• Last Update Date: 2022-05-18

Provider Licenses

State	License ID	Taxonomies
OK	1886232576	332B00000X
		332BC3200X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BC3200X	Suppliers	Durable Medical Equipment & Medical Supplies	Customized Equipment

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NV	1639160708	Medicaid
OH	2484093	Medicaid
RI	8860001	Medicaid
DC	052070200	Medicaid
OK	200001560A	Medicaid
MO	625995808	Medicaid
KY	7100096610	Medicaid
WA	9055500	Medicaid
MD	001528800	Medicaid
AR	152077716	Medicaid
ID	1639160708-000	Medicaid
IA	0578997	Medicaid
AK	1021600	Medicaid
IN	200505230A	Medicaid
MN	717660100	Medicaid
SD	9167680	Medicaid
CT	008068711	Medicaid
NJ	0198056	Medicaid
NM	79972896	Medicaid
VT	1026200	Medicaid
NH	3071425	Medicaid
TN	4582324	Medicaid
WY	119251500	Medicaid
MT	5606991	Medicaid
VA	010082897	Medicaid
MS	03478309	Medicaid
NY	04322405	Medicaid
ME	102650016	Medicaid
AZ	842915	Medicaid
OH	2484093	Medicaid
MT	5606991	Medicaid
UT	=========001	Medicaid
UT	=========001	Medicaid
OH	2484093	Medicaid
MT	5606991	Medicaid