Provider Demographics
NPI:1669573267
Name:MACH ONE MEDICAL, INC.
Entity type:Organization
Organization Name:MACH ONE MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:LOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-208-1282
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-0369
Mailing Address - Country:US
Mailing Address - Phone:918-790-2305
Mailing Address - Fax:918-790-2305
Practice Address - Street 1:107 E CREEK AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-4652
Practice Address - Country:US
Practice Address - Phone:918-790-2305
Practice Address - Fax:918-790-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies