Provider Demographics
NPI:1770580599
Name:LOIS M CHAPPELL-BOSOMFRIEND
Entity type:Organization
Organization Name:LOIS M CHAPPELL-BOSOMFRIEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:405-677-3907
Mailing Address - Street 1:5221 SE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-4505
Mailing Address - Country:US
Mailing Address - Phone:405-677-3907
Mailing Address - Fax:405-677-4886
Practice Address - Street 1:5221 SE 12TH ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4505
Practice Address - Country:US
Practice Address - Phone:405-677-3907
Practice Address - Fax:405-677-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0273910001Medicare NSC