Provider Demographics
NPI:1093008385
Name:ECLIPSE THERAPY SOLUTION
Entity type:Organization
Organization Name:ECLIPSE THERAPY SOLUTION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-601-6767
Mailing Address - Street 1:PO BOX 268946
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8946
Mailing Address - Country:US
Mailing Address - Phone:405-601-6767
Mailing Address - Fax:405-601-6761
Practice Address - Street 1:3112 COOKE WAY
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-2401
Practice Address - Country:US
Practice Address - Phone:405-601-6767
Practice Address - Fax:405-601-6761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-19
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200402780AOtherOHCA OKLAHOMA MEDICAID
OK1093008385OtherBCBS OF OKLAHOMA
OK200402780AOtherOHCA OKLAHOMA MEDICAID