Provider Demographics
NPI:1528455003
Name:MEDICAL MART, INC.
Entity type:Organization
Organization Name:MEDICAL MART, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THAYNE
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-928-4350
Mailing Address - Street 1:623 N PORTER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6072
Mailing Address - Country:US
Mailing Address - Phone:405-928-4350
Mailing Address - Fax:405-928-4351
Practice Address - Street 1:623 N PORTER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6072
Practice Address - Country:US
Practice Address - Phone:405-928-4350
Practice Address - Fax:405-928-4351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies