Provider Demographics
NPI:1710287404
Name:OKLAHOMA SPINE AND BRACE INC.
Entity Type:Organization
Organization Name:OKLAHOMA SPINE AND BRACE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DME REHAB SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-550-3596
Mailing Address - Street 1:3201 NW 54TH CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5312
Mailing Address - Country:US
Mailing Address - Phone:405-550-3596
Mailing Address - Fax:405-606-2508
Practice Address - Street 1:3201 NW 54TH CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5312
Practice Address - Country:US
Practice Address - Phone:405-550-3596
Practice Address - Fax:405-606-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies