Provider Demographics
NPI:1639195092
Name:NIX'S MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:NIX'S MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:NIX
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:918-775-7778
Mailing Address - Street 1:PO BOX 940
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0940
Mailing Address - Country:US
Mailing Address - Phone:918-775-7778
Mailing Address - Fax:918-775-7770
Practice Address - Street 1:103 SIOUX ST
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-5229
Practice Address - Country:US
Practice Address - Phone:918-775-7778
Practice Address - Fax:918-775-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Not Answered332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS & BLUE SHIELD
OK=========001OtherBLUE CROSS & BLUE SHIELD