| Organization Name: | PROSOURCE MEDICAL EQUIPMENT AND SUPPLIES |
| NPI Number: | 1114917747 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN RUSSELL WEBB (ADMINISTRATOR) |
| Mailing Address: | 6801 S Eastern Ave Oklahoma City |
| State: | OK US |
| Postal Code: | 731492300 |
| Phone Number: | 8886913237 |
| Fax Number: | 4056913395 |
| NPI Enumeration Date: | 10/25/2005 |
| NPI Last Update Date: | 10/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 117978 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |