Provider Demographics
NPI:1699339804
Name:OKLAHOMA MOBILE PODIATRY SERVICES LLC
Entity type:Organization
Organization Name:OKLAHOMA MOBILE PODIATRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:054-285-8900
Mailing Address - Street 1:2300 S BROADWAY STE 110
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-4065
Mailing Address - Country:US
Mailing Address - Phone:405-285-8900
Mailing Address - Fax:
Practice Address - Street 1:2300 S BROADWAY STE 110
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-4065
Practice Address - Country:US
Practice Address - Phone:405-285-8900
Practice Address - Fax:405-285-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty