Provider Demographics
NPI:1427175892
Name:OKLAHOMA LIMB & BRACE CO.
Entity type:Organization
Organization Name:OKLAHOMA LIMB & BRACE CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:HERONEME
Authorized Official - Suffix:SR
Authorized Official - Credentials:CP
Authorized Official - Phone:918-426-4424
Mailing Address - Street 1:125 S MAIN ST # 346
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5363
Mailing Address - Country:US
Mailing Address - Phone:918-426-4424
Mailing Address - Fax:918-426-4460
Practice Address - Street 1:1023 S 2ND ST
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-6401
Practice Address - Country:US
Practice Address - Phone:918-426-4424
Practice Address - Fax:918-426-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812800AMedicaid