| NPI | 1851847297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRON JANEAN BULLOCK Hair Loss Specialist 405-501-6402 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier (Licence: OK 94711) |
| Additional Taxonomies | 251B00000X Case Management (Licence: OK 94711) |
| 302F00000X Exclusive Provider Organization (Licence: OK 94711) | |
| 305R00000X Preferred Provider Organization (Licence: OK 94711) | |
| 305S00000X Point of Service (Licence: OK 94711) | |
| 332BC3200X Durable Medical Equipment & Medical Supplies Customized Equipment (Licence: OK 94711) | |
| Enumeration Date | 2016-08-26 |
| Last Update Date | 2016-08-26 |