| Doris Jane Chediak,m.s.w., Inc. | |
|
3037 Nw 63rd St Suite 100w Oklahoma City OK 73116-3637 | |
| (405) 843-3800 | |
| Not Available |
| Full Name | Doris Jane Chediak,m.s.w., Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3037 Nw 63rd St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Doris Jane Chediak (PRESIDENT) |
| Authorized Official Contact | 4058433800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Doris Jane Chediak,m.s.w., Inc. 3037 Nw 63rd St Suite 100w Oklahoma City OK 73116-3637 Ph: (405) 843-3800 | Doris Jane Chediak,m.s.w., Inc. 3037 Nw 63rd St Suite 100w Oklahoma City OK 73116-3637 Ph: (405) 843-3800 |
| NPI Number | 1770811242 |
|---|---|
| Provider Enumeration Date | 11/22/2009 |
| Last Update Date | 11/22/2009 |
| Medicare PECOS PAC ID | 7618017187 |
|---|---|
| Medicare Enrollment ID | O20091214000317 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770811242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 183 (Oklahoma) | Primary |
| Provider Name | Doris J Chediak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1063515690 PECOS PAC ID: 4486793114 Enrollment ID: I20091209000272 |
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