Organization
BLACK BEAVER MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN PATRICK AYRES (BILLING MANAGER)
(405) 923-1993
Entity
Organization
Contact information
Practice address
123 E BROADWAY ST, ANADARKO, OK 73005-2823
(405) 923-1993
Mailing address
123 E BROADWAY ST, ANADARKO, OK 73005-2823
(405) 923-1993
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/05/2023
Last updated
04/30/2023
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