Provider Demographics
NPI:1396750873
Name:SHERRILL'S RESPIRATORY & DIABETIC
Entity type:Organization
Organization Name:SHERRILL'S RESPIRATORY & DIABETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALT
Authorized Official - Middle Name:T
Authorized Official - Last Name:SAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-286-5745
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728-1247
Mailing Address - Country:US
Mailing Address - Phone:580-286-5745
Mailing Address - Fax:580-286-5742
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728-3973
Practice Address - Country:US
Practice Address - Phone:580-286-5745
Practice Address - Fax:580-286-5742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3634332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherTAX ID #
OK1180620001Medicare ID - Type Unspecified