Organization
GRACE MEDICAL EQUIPMENT, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHAN PAUL PENNINGTON (MANAGING MEMBER)
(918) 453-9600
Entity
Organization
Contact information
Practice address
1516 N. GRAND AVE, TAHLEQUAH, OK 74464
(918) 453-9600
(918) 453-9601
Mailing address
1516 N GRAND AVE, TAHLEQUAH, OK 74464-6318
(918) 453-9600
(918) 453-9601
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
36-S-1169
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200081550A
—
OK
Enumeration date
10/03/2006
Last updated
12/03/2015
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