Provider Demographics
NPI:1699899138
Name:B & A MEDICAL SUPPLY
Entity type:Organization
Organization Name:B & A MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:580-335-7334
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:301 N 13TH ST
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-0946
Mailing Address - Country:US
Mailing Address - Phone:580-335-7334
Mailing Address - Fax:580-335-7445
Practice Address - Street 1:301 N 13TH ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-4405
Practice Address - Country:US
Practice Address - Phone:580-335-7334
Practice Address - Fax:580-335-7445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK888623332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5946020001Medicare NSC