Echelon Medical LLC

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

25-S-1186 Issued in OK

Legal business name

ECHELON MEDICAL LLC

Practice address

1430 Lincoln Rd
Idabel, OK 74745

Phone

(580) 286-9700

Fax

(580) 286-9702

NPI assigned

Jul 10, 2006

Last updated

Apr 23, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Lee Kisthardt

Title

Manager

Phone

(405) 848-5130

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1598799504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 LINCOLN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747459999",
            "telephone_number": "405-848-5130",
            "fax_number": "405-848-5102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 LINCOLN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "74745",
            "telephone_number": "580-286-9700",
            "fax_number": "580-286-9702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ECHELON MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "KISTHARDT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "405-848-5130",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "OK",
            "license": "25-S-1186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oxygen Equipment & Supplies (DME) in Idabel, OK
• Providers in Idabel, OK by specialty
• Oxygen Equipment & Supplies (DME) in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 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.