| Life Vision | |
|
2101 N Ash St Ponca City OK 74601-1106 | |
| (580) 716-4787 | |
| Not Available |
| Full Name | Life Vision |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2101 N Ash St, Ponca City, Oklahoma |
| Authorized Official Name and Position | Tera Biaggi (CLINICAL DIRECTOR) |
| Authorized Official Contact | 5807164787 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Vision 11605 S Q St Ponca City OK 74601-7565 Ph: (580) 716-4787 | Life Vision 2101 N Ash St Ponca City OK 74601-1106 Ph: (580) 716-4787 |
| NPI Number | 1699102640 |
|---|---|
| Provider Enumeration Date | 10/07/2013 |
| Last Update Date | 10/07/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699102640 | NPI | - | NPPES |
| 200288910C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3696 (Oklahoma) | Primary |
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