Provider Demographics
NPI:1700194701
Name:ABIDE MEDICAL LLC
Entity Type:Organization
Organization Name:ABIDE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:FUSTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:405-314-1049
Mailing Address - Street 1:1920 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2823
Mailing Address - Country:US
Mailing Address - Phone:405-314-1049
Mailing Address - Fax:
Practice Address - Street 1:1920 NW 38TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2823
Practice Address - Country:US
Practice Address - Phone:405-314-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies