Provider Demographics
NPI:1730171471
Name:LKM ENTERPRISES, INC
Entity type:Organization
Organization Name:LKM ENTERPRISES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-252-3111
Mailing Address - Street 1:7112 S MINGO ROAD
Mailing Address - Street 2:SUITE 104A
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3664
Mailing Address - Country:US
Mailing Address - Phone:918-252-3111
Mailing Address - Fax:918-252-9222
Practice Address - Street 1:7112 S MINGO RD
Practice Address - Street 2:SUITE 104A
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3664
Practice Address - Country:US
Practice Address - Phone:918-252-3111
Practice Address - Fax:918-252-9222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LKM ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-18
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200017890AMedicaid
OK4850440001Medicare ID - Type UnspecifiedMEDICARE