Provider Demographics
NPI:1760446538
Name:TEXOMA MEDICAL SERVICES INC
Entity Type:Organization
Organization Name:TEXOMA MEDICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-328-5208
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TALOGA
Mailing Address - State:OK
Mailing Address - Zip Code:73667-0236
Mailing Address - Country:US
Mailing Address - Phone:580-328-5208
Mailing Address - Fax:580-328-5211
Practice Address - Street 1:212 E DATE ST
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859-5321
Practice Address - Country:US
Practice Address - Phone:918-623-0988
Practice Address - Fax:918-623-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846370LMedicaid
=========001OtherBLUE CROSS BLUE SHIELD
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1051910002Medicare ID - Type Unspecified