Provider Demographics
NPI:1790785657
Name:ACS MEDICAL LLC
Entity Type:Organization
Organization Name:ACS MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-879-1800
Mailing Address - Street 1:6516 N OLIE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7399
Mailing Address - Country:US
Mailing Address - Phone:405-879-1800
Mailing Address - Fax:405-879-1805
Practice Address - Street 1:6516 N OLIE AVE
Practice Address - Street 2:STE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7399
Practice Address - Country:US
Practice Address - Phone:405-879-1800
Practice Address - Fax:405-879-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200033940AMedicaid
OK5157550001Medicare NSC