Organization
WAGONER MOBILITY & MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN KEITH STEVENS (MANAGER)
(918) 260-4687
Entity
Organization
Contact information
Practice address
30 ELM DR, PRYOR, OK 74361-4456
(918) 260-4687
(187) 735-2918
Mailing address
1202 N NAVAJO ST, CHOUTEAU, OK 74337-3700
(918) 527-6404
(187) 735-2918
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
01/31/2011
Last updated
01/31/2011
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