Provider Demographics
NPI:1902832488
Name:ASBURY MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ASBURY MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-858-0097
Mailing Address - Street 1:3401 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-6904
Mailing Address - Country:US
Mailing Address - Phone:405-858-0097
Mailing Address - Fax:405-858-0119
Practice Address - Street 1:3401 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-6904
Practice Address - Country:US
Practice Address - Phone:405-858-0097
Practice Address - Fax:405-858-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100812960AMedicaid
OK4136550001Medicare NSC