Provider Demographics
NPI:1740345107
Name:MEDDY ASSOCIATES
Entity type:Organization
Organization Name:MEDDY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:MBOSOWO
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:405-948-0777
Mailing Address - Street 1:2324 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2208
Mailing Address - Country:US
Mailing Address - Phone:405-948-0777
Mailing Address - Fax:405-948-1777
Practice Address - Street 1:2324 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2208
Practice Address - Country:US
Practice Address - Phone:405-948-0777
Practice Address - Fax:405-948-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4814570001Medicare NSC