Provider Demographics
NPI:1215977251
Name:HUGH A MENDEZ
Entity type:Organization
Organization Name:HUGH A MENDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:580-832-2488
Mailing Address - Street 1:116 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-4824
Mailing Address - Country:US
Mailing Address - Phone:580-832-2488
Mailing Address - Fax:580-832-2488
Practice Address - Street 1:116 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORDELL
Practice Address - State:OK
Practice Address - Zip Code:73632-4824
Practice Address - Country:US
Practice Address - Phone:580-832-2488
Practice Address - Fax:580-832-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100796430AMedicaid
OK1276310001Medicare NSC