Organization
CROAS1 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHAJA MOHAMMED (OWNER)
(312) 804-5076
Entity
Organization
Contact information
Practice address
300 N 5TH ST, PONCA CITY, OK 74601-4512
(580) 762-1291
Mailing address
300 N 5TH ST, PONCA CITY, OK 74601-4512
(580) 762-1291
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
05/10/2016
Last updated
07/22/2024
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