Organization
KINGDOM MEDICAL EQUIPMENT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY HILLIARD (MANAGING MEMBER)
(580) 355-1511
Entity
Organization
Contact information
Practice address
1824 NW 52ND ST, LAWTON, OK 73505-3122
(580) 355-1511
(580) 355-0455
Mailing address
1834 NW 52ND ST, LAWTON, OK 73505-3122
(580) 355-1511
(580) 355-0455
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200073650 A
—
OK
05
—
200073650 B
—
OK
Enumeration date
08/16/2006
Last updated
11/20/2018
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