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Organization
SHAWNEE PEDORTHIC SERVICE, INC.
Active
Organization
SHAWNEE PEDORTHIC SERVICE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA S KRIWANEK C.PED., L.PED. (OWNER, SECRETARY OF CORP.)
(405) 275-1996
Entity
Organization
Contact information
Practice address
1510 N KICKAPOO AVE, SUITE 11, SHAWNEE, OK 74804-4331
(405) 275-1996
(405) 275-0809
Mailing address
1510 N KICKAPOO AVE, SUITE 11, SHAWNEE, OK 74804-4331
(405) 275-1996
(405) 275-0809
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
16
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100808590 A
—
OK
01
—
731580812001
BLUECROSS BLUESHIELD PIN
OK
Enumeration date
09/20/2006
Last updated
09/30/2014
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