Provider Demographics
NPI:1699826271
Name:BEVERLY A HELMS
Entity Type:Organization
Organization Name:BEVERLY A HELMS
Other - Org Name:GRAND PROSTHETICS AND ORTHOTICS LIGHTWEIGHT ARTIFICIAL LIMBS BRACES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER PROFESSIONAL PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HELMS
Authorized Official - Suffix:
Authorized Official - Credentials:CLPO RN
Authorized Official - Phone:918-786-4626
Mailing Address - Street 1:PO BOX 451557
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-1557
Mailing Address - Country:US
Mailing Address - Phone:918-786-4626
Mailing Address - Fax:801-998-0979
Practice Address - Street 1:5 E 14TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-5347
Practice Address - Country:US
Practice Address - Phone:918-786-4626
Practice Address - Fax:801-998-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO24335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1171400001Medicare NSC