Organization
ECLIPSE THERAPY SOLUTION
Active
Other names
None
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TREVOR NUTT (PRINCIPAL)
(405) 601-6767
Entity
Organization
Contact information
Practice address
3112 COOKE WAY, OKLAHOMA CITY, OK 73179-2401
(405) 601-6767
(405) 601-6761
Mailing address
PO BOX 268946, OKLAHOMA CITY, OK 73126-8946
(405) 601-6767
(405) 601-6761
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093008385
BCBS OF OKLAHOMA
OK
01
—
200402780A
OHCA OKLAHOMA MEDICAID
OK
Enumeration date
05/19/2011
Last updated
05/18/2012
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