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 |