Organization
PRIME SOURCE DME OF OKLAHOMA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA WALLACE (ADMINISTRATION MANAGER)
(918) 935-2088
Entity
Organization
Contact information
Practice address
6810 E 40TH ST STE A, TULSA, OK 74145-4510
(918) 935-2088
(918) 935-2087
Mailing address
6810 E 40TH ST STE A, TULSA, OK 74145-4510
(918) 935-2088
(918) 935-2087
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
—
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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