| Autumn Life Center | |
|
1 S Bryant Ave Edmond OK 73034-6309 | |
| (405) 341-6100 | |
| Not Available |
| Full Name | Autumn Life Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1 S Bryant Ave, Edmond, Oklahoma |
| Authorized Official Name and Position | James Michael Watson (CFO) |
| Authorized Official Contact | 4052715100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Autumn Life Center 1200 Everett Dr Oklahoma City OK 73104-5047 Ph: (405) 271-5100 | Autumn Life Center 1 S Bryant Ave Edmond OK 73034-6309 Ph: (405) 341-6100 |
| NPI Number | 1609390111 |
|---|---|
| Provider Enumeration Date | 07/27/2017 |
| Last Update Date | 12/11/2017 |
| Medicare PECOS PAC ID | 8628339900 |
|---|---|
| Medicare Enrollment ID | O20180327002175 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609390111 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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