Organization
INNOVATIVE MEDICAL SUPPLY, LLC
Active
Other names
iMed Supply
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN K BERRY (MEMBER)
(405) 799-8855
Entity
Organization
Contact information
Practice address
1501 SE 4TH ST, SUITE D, MOORE, OK 73160-8231
(405) 799-8855
(405) 799-8860
Mailing address
1501 SE 4TH ST, MOORE, OK 73160-8231
(405) 799-8855
(405) 799-8860
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2023000A
—
OK
01
—
20536475001
TRICARE PROVIDER NUMBER
OK
01
—
209078400
DEPT OF LABOR PROVIDER #
OK
Enumeration date
06/30/2005
Last updated
08/27/2025
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