Provider Demographics
NPI:1700012614
Name:LITHO OF AMERICA, LLC
Entity Type:Organization
Organization Name:LITHO OF AMERICA, LLC
Other - Org Name:LOA MOBILE MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF MEDICAL OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCELRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-826-4005
Mailing Address - Street 1:3637 E. I-240 BUSINESS PARK
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73135
Mailing Address - Country:US
Mailing Address - Phone:800-475-4661
Mailing Address - Fax:877-769-2350
Practice Address - Street 1:3637 E. I-240 BUSINESS PARK
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135
Practice Address - Country:US
Practice Address - Phone:800-475-4661
Practice Address - Fax:877-769-2350
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LITHO OF AMERICA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-05
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QL0400XAmbulatory Health Care FacilitiesClinic/CenterLithotripsy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies