Basic Information
| Provider Information | |||||||||
| NPI: | 1215013321 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | D & D SERVICES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | PREFERRED PEDIATRIC HOME HEALTH CARE, INC. | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 12331 E 60TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741466904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182522000 | ||||||||
| FaxNumber: | 9182522007 | ||||||||
| Practice Location | |||||||||
| Address1: | 12331 E 60TH ST | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182522000 | ||||||||
| FaxNumber: | 9182522007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 05/15/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DOSS | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | C.E.O | ||||||||
| AuthorizedOfficialTelephone: | 9182522000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | R.N. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336C0004X | 2-4721 | OK | N | Suppliers | Pharmacy | Compounding Pharmacy | 3336H0001X | 2-4721 | OK | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 333600000X | 2-4721 | OK | Y | Suppliers | Pharmacy |
ID Information
| ID | Type | State | Issuer | Description | 3723726 | 01 | OK | NCPDP | OTHER | 100260990G | 05 | OK | MEDICAID |