Provider Demographics
NPI:1790960474
Name:INDEPENDENCE TECHNOLOGIES
Entity Type:Organization
Organization Name:INDEPENDENCE TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PENTECOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-282-6111
Mailing Address - Street 1:2608 W KENOSHA ST
Mailing Address - Street 2:SUITE 622
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-8952
Mailing Address - Country:US
Mailing Address - Phone:918-249-5065
Mailing Address - Fax:918-249-5075
Practice Address - Street 1:1725 W RENO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1460
Practice Address - Country:US
Practice Address - Phone:918-249-5065
Practice Address - Fax:918-249-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333300000XSuppliersEmergency Response System Companies