Provider Demographics
NPI:1427054337
Name:SAUNDRA S BASEY HERRIAGE
Entity type:Organization
Organization Name:SAUNDRA S BASEY HERRIAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAUNDRA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HERRIAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-752-1291
Mailing Address - Street 1:10412 CONDOR TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-4439
Mailing Address - Country:US
Mailing Address - Phone:405-720-9002
Mailing Address - Fax:
Practice Address - Street 1:5806 NW 63RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-7735
Practice Address - Country:US
Practice Address - Phone:405-752-1291
Practice Address - Fax:405-842-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK0962180001Medicare NSC