Provider Demographics
NPI:1740359686
Name:DOUG'S REPAIR SERVICE
Entity type:Organization
Organization Name:DOUG'S REPAIR SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:FAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-266-5521
Mailing Address - Street 1:25656 SO. 4110 RD.FAAS.
Mailing Address - Street 2:NONE
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2364
Mailing Address - Country:US
Mailing Address - Phone:918-266-5521
Mailing Address - Fax:918-266-5521
Practice Address - Street 1:25656 SO. 4110 RD.FAAS.
Practice Address - Street 2:NONE
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2364
Practice Address - Country:US
Practice Address - Phone:918-266-5521
Practice Address - Fax:918-266-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies