NPIMap

Organization Active NPI

Mercer Beauty Supply

  • Prosthetic/Orthotic Supplier
  • Lawton, OK
National Provider Identifier
1053506121
Registry record updated Jul 16, 2008
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Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
License
22498 001 Issued in OK
Legal business name
MERCER BEAUTY SUPPLY
Practice address
1016 SW D Ave
Lawton, OK 73501
Phone
(580) 353-0690
NPI assigned
Sep 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Iva L Black
Title
Owner
Phone
(580) 353-0690

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotic FitterGroup: 193400000X SINGLE SPECIALTY GROUP 225000000X 22498 001 OK
Prosthetic/Orthotic Supplier 335E00000X 22498 001 OK Primary

Addresses

Primary practice location

1016 SW D Ave
Lawton, OK 73501

Mailing address

1016 SW D Ave
Lawton, OK 73501
Phone (580) 353-0690

National Provider Directory

National Provider Directory

Locations

1016 SW D Ave
Lawton, OK 73501
Phone (580) 353-0690

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1053506121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 SW D AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73501",
            "telephone_number": "580-353-0690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 SW D AVE",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73501",
            "telephone_number": "580-353-0690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCER BEAUTY SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-11",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "IVA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-353-0690",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthotic Fitter",
            "state": "OK",
            "license": "22498 001",
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "OK",
            "license": "22498 001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.