Organization
JIREH MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE DEAN RACKLEY (PRESIDENT)
(918) 827-7600
Entity
Organization
Contact information
Practice address
1312 COMMERCIAL AVE, MOUNDS, OK 74047-0000
(918) 827-7600
(918) 827-7667
Mailing address
PO BOX 308, MOUNDS, OK 74047-0308
(918) 827-7600
(918) 827-7667
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
11-6330
OK
333600000X
Pharmacy
11-6330
OK
3336C0003X
Community/Retail Pharmacy
11-6330
OK
3336L0003X
Long Term Care Pharmacy
11-6330
OK
Other
Enumeration date
04/30/2007
Last updated
06/18/2013
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