Provider Demographics
NPI:1306946678
Name:GUTHRIE HOME CARE MEDICAL EQUIPMENT COMPANY LLC
Entity type:Organization
Organization Name:GUTHRIE HOME CARE MEDICAL EQUIPMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NEWTON
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:405-282-6676
Mailing Address - Street 1:307 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-3203
Mailing Address - Country:US
Mailing Address - Phone:405-282-6676
Mailing Address - Fax:405-282-7769
Practice Address - Street 1:307 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-3203
Practice Address - Country:US
Practice Address - Phone:405-282-6676
Practice Address - Fax:405-282-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100811010AMedicaid
0912130001Medicare ID - Type Unspecified