Provider Demographics
NPI:1801802699
Name:MARBLE WORKS OF LAWTON
Entity type:Organization
Organization Name:MARBLE WORKS OF LAWTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-357-8664
Mailing Address - Street 1:200 SW C AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-4600
Mailing Address - Country:US
Mailing Address - Phone:580-357-8664
Mailing Address - Fax:580-354-9050
Practice Address - Street 1:200 SW C AVE.
Practice Address - Street 2:SUITE 14
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-4600
Practice Address - Country:US
Practice Address - Phone:580-357-8664
Practice Address - Fax:580-354-9050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK847868332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment