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Organization
SERVICE MASTER MEDICAL LLC
Active
Organization
SERVICE MASTER MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAWN DALE MCCLANAHAN CPED (OWNER)
(405) 222-4411
Entity
Organization
Contact information
Practice address
2101 W IOWA AVE, CHICKASHA, OK 73018-2737
(405) 222-4411
(405) 222-4426
Mailing address
2101 W IOWA AVE, CHICKASHA, OK 73018-2737
(405) 222-4411
(405) 222-4426
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
18S1025
OK
335E00000X
Prosthetic/Orthotic Supplier
20377
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200029110A
—
OK
Enumeration date
08/19/2006
Last updated
12/15/2011
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