Provider Demographics
NPI:1649691650
Name:ECHELON MEDICAL, LLC
Entity type:Organization
Organization Name:ECHELON MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:450-848-5130
Mailing Address - Street 1:401 E CALIFORNIA AVE STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4210
Mailing Address - Country:US
Mailing Address - Phone:405-848-5130
Mailing Address - Fax:405-848-5102
Practice Address - Street 1:7702 E 91ST ST STE 200B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6054
Practice Address - Country:US
Practice Address - Phone:918-949-6942
Practice Address - Fax:918-949-3613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies