Provider Demographics
NPI:1295800068
Name:WOUND MANAGEMENT OF OKLAHOMA, INC.
Entity type:Organization
Organization Name:WOUND MANAGEMENT OF OKLAHOMA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:MURDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-745-7878
Mailing Address - Street 1:PO BOX 271195
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73137-1195
Mailing Address - Country:US
Mailing Address - Phone:405-745-7878
Mailing Address - Fax:405-809-1478
Practice Address - Street 1:2840 S UTAH AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-1703
Practice Address - Country:US
Practice Address - Phone:405-745-7878
Practice Address - Fax:405-809-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100810940AMedicaid
OK200000000854OtherFIDELIS SECURE CARE
MI874964856Medicaid
OK100810940AMedicaid
MI874964856Medicaid