Provider Demographics
NPI:1982757217
Name:MMS OKLAHOMA CITY INC
Entity type:Organization
Organization Name:MMS OKLAHOMA CITY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-763-8222
Mailing Address - Street 1:415 W WILSHIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-7702
Mailing Address - Country:US
Mailing Address - Phone:405-840-5272
Mailing Address - Fax:405-840-5274
Practice Address - Street 1:415 W WILSHIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7702
Practice Address - Country:US
Practice Address - Phone:405-840-5272
Practice Address - Fax:405-840-5274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X
OK1-S-802332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR74410Medicaid
OR74410Medicaid