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Organization
ECHELON MEDICAL LLC
Active
Organization
ECHELON MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL LEE KISTHARDT (MANAGER)
(405) 848-5130
Entity
Organization
Contact information
Practice address
1430 LINCOLN RD, IDABEL, OK 74745
(580) 286-9700
(580) 286-9702
Mailing address
1430 LINCOLN RD, IDABEL, OK 74745-9999
(405) 848-5130
(405) 848-5102
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
25-S-1186
OK
Other
Enumeration date
07/10/2006
Last updated
04/23/2008
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