Provider Demographics
NPI:1174768774
Name:TEXOMA MEDICAL SERVICE, INC.
Entity type:Organization
Organization Name:TEXOMA MEDICAL SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-922-4403
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:TALOGA
Mailing Address - State:OK
Mailing Address - Zip Code:73667-0236
Mailing Address - Country:US
Mailing Address - Phone:580-328-5208
Mailing Address - Fax:580-328-5211
Practice Address - Street 1:908 N.W. HIGHWAY 270
Practice Address - Street 2:STE. A
Practice Address - City:SEILING
Practice Address - State:OK
Practice Address - Zip Code:73663
Practice Address - Country:US
Practice Address - Phone:580-922-4403
Practice Address - Fax:580-922-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
OK7053623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100846370OMedicaid
2118541OtherPK
2118541OtherPK