Organization
PRESTIGE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN JACKSON (OWNER/CEO)
(405) 724-6630
Entity
Organization
Contact information
Practice address
1109 N BRYANT AVE, STE 110, EDMOND, OK 73034-3255
(405) 458-1777
(405) 458-1777
Mailing address
1109 N BRYANT AVE, STE 110, EDMOND, OK 73034-3255
(405) 458-1777
(405) 458-1777
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
—
—
Other
Enumeration date
12/04/2019
Last updated
12/04/2019
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