Organization
U.S. ALERT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY YOUNG (CEO/PRESIDENT)
(580) 272-0303
Entity
Organization
Contact information
Practice address
22131 COUNTY ROAD 1560, STONEWALL, OK 74871-6471
(580) 272-0303
(801) 659-4116
Mailing address
22131 COUNTY ROAD 1560, STONEWALL, OK 74871-6471
(580) 272-0303
(801) 659-4116
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
774
OK
305R00000X
Preferred Provider Organization
774
OK
315D00000X
Inpatient Hospice
774
OK
332B00000X
Durable Medical Equipment & Medical Supplies
774
OK
332BC3200X
Customized Equipment (DME)
Primary
774
OK
333300000X
Emergency Response System Companies
774
OK
Other
Enumeration date
04/29/2010
Last updated
07/27/2010
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