Provider Demographics
NPI:1164458584
Name:MED-ONE, INC
Entity type:Organization
Organization Name:MED-ONE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:BERSANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-526-3363
Mailing Address - Street 1:2811 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2524
Mailing Address - Country:US
Mailing Address - Phone:903-526-3363
Mailing Address - Fax:903-526-0205
Practice Address - Street 1:729 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6778
Practice Address - Country:US
Practice Address - Phone:405-324-5711
Practice Address - Fax:405-324-5470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200027300AMedicaid
OK5020000001Medicare NSC