Provider Demographics
NPI:1679568125
Name:TIM CARLTON PROSTHETICS INC.
Entity type:Organization
Organization Name:TIM CARLTON PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROSTHETIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:CP LP
Authorized Official - Phone:405-721-7570
Mailing Address - Street 1:9414 WESTGATE RD
Mailing Address - Street 2:SUITE B.
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6245
Mailing Address - Country:US
Mailing Address - Phone:405-721-7570
Mailing Address - Fax:405-721-7599
Practice Address - Street 1:9414 WESTGATE RD
Practice Address - Street 2:SUITE B.
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6245
Practice Address - Country:US
Practice Address - Phone:405-721-7570
Practice Address - Fax:405-721-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5189020001Medicare NSC