Provider Demographics
NPI:1982878724
Name:GAGE LUCKY 13 LLC
Entity Type:Organization
Organization Name:GAGE LUCKY 13 LLC
Other - Org Name:TECUMSEH OXYGEN AND MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-598-8629
Mailing Address - Street 1:503 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:OK
Mailing Address - Zip Code:74873
Mailing Address - Country:US
Mailing Address - Phone:405-598-0223
Mailing Address - Fax:405-598-2833
Practice Address - Street 1:503 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:OK
Practice Address - Zip Code:74873
Practice Address - Country:US
Practice Address - Phone:405-598-0223
Practice Address - Fax:405-598-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200199380AMedicaid
6125930001Medicare NSC