Provider Demographics
NPI:1699832071
Name:WADE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:WADE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-228-2899
Mailing Address - Street 1:104 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAURIKA
Mailing Address - State:OK
Mailing Address - Zip Code:73573-3054
Mailing Address - Country:US
Mailing Address - Phone:580-228-2899
Mailing Address - Fax:
Practice Address - Street 1:104 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAURIKA
Practice Address - State:OK
Practice Address - Zip Code:73573-3054
Practice Address - Country:US
Practice Address - Phone:580-228-2899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
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
OK1132350001Medicare ID - Type Unspecified