Organization
AEGIS ENTERPRISES
Active
Other names
ADVANCED PEDIATRIC CARE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGORY LEE GOODMAN II R.N. (DIRECTOR/OFFICER)
(918) 392-0555
Entity
Organization
Contact information
Practice address
10404 E 55TH PL, SUITE W, TULSA, OK 74146-6500
(918) 392-0555
(918) 392-0556
Mailing address
10404 E 55TH PL, SUITE W, TULSA, OK 74146-6500
(918) 392-0555
(918) 392-0556
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200078770A
—
OK
Enumeration date
05/28/2006
Last updated
02/21/2008
Update your record
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