Individual ProviderEthan BirdwellCase Manager/Care CoordinatorOther Service ProvidersPractice Address1202 Monroe Dr, Shawnee, OK 74804-4139(405) 517-3806PECOS EnrollmentBased on the most recent information from CMS, provider Ethan Birdwell 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 ID1457077190Provider TypeIndividualFull NameBirdwell, EthanGenderMaleSole ProprietorNoEnumeration Date10/14/2022Last Updated10/14/2022Contact InformationPractice LocationPractice Address1202 Monroe Dr, Shawnee, OK 74804-4139Phone(405) 517-3806FaxUnlisted FaxMailing LocationMailing Address1202 Monroe Dr, Shawnee, OK 74804-4139Phone(405) 517-3806FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode171M00000XPrimaryDescriptionCase Manager/Care CoordinatorOther Service ProvidersLicenseUnlisted IssuerOklahoma