Individual ProviderTai KeawphaloukCase Manager/Care CoordinatorOther Service ProvidersPractice Address1010 E 45th St, Shawnee, OK 74804-2202(405) 273-7493(405) 273-1170PECOS EnrollmentBased on the most recent information from CMS, provider Tai Keawphalouk does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1093209116Provider TypeIndividualFull NameKeawphalouk, TaiTitleMr.GenderMaleSole ProprietorYesEnumeration Date6/21/2018Last Updated6/21/2018Contact InformationPractice LocationPractice Address1010 E 45th St, Shawnee, OK 74804-2202Phone(405) 273-7493FaxUnlisted FaxMailing LocationMailing Address1010 E 45th St, Shawnee, OK 74804-2202Phone(405) 273-1170FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted Issuer