Organization
MED-X CORPORATION
Active
Other names
MED-X DRUG #14
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY M. BOONE (DIRECTOR OF HME OPERATIONS)
(479) 394-6363
Entity
Organization
Contact information
Practice address
1339 E 41ST ST, TULSA, OK 74105-4031
(918) 744-5490
(918) 743-1051
Mailing address
2100 BROOKWOOD DR, LITTLE ROCK, AR 72202-1734
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
22630
OK
333600000X
Pharmacy
22630
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100233260L
—
OK
01
—
100246210K
MEDICAID DME
OK
01
—
3714032
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
400522490
MEDICARE FLU
OK
Enumeration date
10/25/2006
Last updated
11/04/2008
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