Black Beaver Medical Supply LLC

Key facts

NPI

1013602135

Entity type

Organization (NPI type 2)

Primary specialty

Durable Medical Equipment & Medical Supplies 332B00000X

Legal business name

BLACK BEAVER MEDICAL SUPPLY LLC

Practice address

123 E Broadway St
Anadarko, OK 73005-2823

Phone

(405) 923-1993

NPI assigned

Apr 5, 2023

Organization subpart

No

Authorized official

Name

Justin Patrick Ayres

Title

Billing Manager

Phone

(405) 923-1993

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 30, 2023.

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682812800000",
    "number": "1013602135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 E BROADWAY ST",
            "city": "ANADARKO",
            "state": "OK",
            "postal_code": "730052823",
            "telephone_number": "405-923-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 E BROADWAY ST",
            "city": "ANADARKO",
            "state": "OK",
            "postal_code": "730052823",
            "telephone_number": "405-923-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK BEAVER MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-05",
        "last_updated": "2023-04-30",
        "certification_date": "2023-04-30",
        "status": "A",
        "authorized_official_last_name": "AYRES",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "405-923-1993"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anadarko, OK

• Rose H. Autaubo, LPN
• Mario Luis Avila
• Jordan Taylor Bearshield
• Jay C Belt, DO
• Carmen B Bird Pico, MD
• Wesley H Boothe
• Mickey Sue Bottom
• Donald Thomas Brock, DO
• Wendy Marie Brown, NP
• Kathryn Louise Butler

All providers in Anadarko, OK · Durable Medical Equipment & Medical Supplies in Oklahoma