Provider Demographics
NPI:1205957826
Name:H AND M MEDICAL SERVICE
Entity type:Organization
Organization Name:H AND M MEDICAL SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-201-2629
Mailing Address - Street 1:PO BOX 5124
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73083-5124
Mailing Address - Country:US
Mailing Address - Phone:405-201-2629
Mailing Address - Fax:
Practice Address - Street 1:6530 E 21ST ST STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-1274
Practice Address - Country:US
Practice Address - Phone:405-201-2629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200040900AMedicaid
OK200040900AMedicaid