Provider Demographics
NPI:1669548533
Name:EARCARE OF PONCA CITY, INC.
Entity type:Organization
Organization Name:EARCARE OF PONCA CITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRECHEISEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-718-9991
Mailing Address - Street 1:2010 N 14TH
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601
Mailing Address - Country:US
Mailing Address - Phone:580-718-9991
Mailing Address - Fax:580-718-9993
Practice Address - Street 1:2010 NORTH 14TH
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601
Practice Address - Country:US
Practice Address - Phone:580-718-9991
Practice Address - Fax:580-718-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSCE569332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment