Provider Demographics
NPI:1972782431
Name:SOLE FX, LLC
Entity Type:Organization
Organization Name:SOLE FX, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:CPED, LPED
Authorized Official - Phone:918-609-6136
Mailing Address - Street 1:12711 E 86TH PL N
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2695
Mailing Address - Country:US
Mailing Address - Phone:918-609-6136
Mailing Address - Fax:918-609-6136
Practice Address - Street 1:12711 E 86TH PL N
Practice Address - Street 2:SUITE 105
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2695
Practice Address - Country:US
Practice Address - Phone:918-609-6136
Practice Address - Fax:918-609-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK104332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK6040040001Medicare NSC