| Mind And Body Medical Clinic | |
|
2216 Nw 164th St Ste A Edmond OK 73013-9078 | |
| (405) 285-4755 | |
| (405) 215-3760 |
| Full Name | Mind And Body Medical Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2216 Nw 164th St Ste A, Edmond, Oklahoma |
| Authorized Official Name and Position | Kelli Leek (CO-OWNER) |
| Authorized Official Contact | 4052854755 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mind And Body Medical Clinic 2216 Nw 164th St Ste A Edmond OK 73013-9078 Ph: (405) 285-4755 | Mind And Body Medical Clinic 2216 Nw 164th St Ste A Edmond OK 73013-9078 Ph: (405) 285-4755 |
| NPI Number | 1497223846 |
|---|---|
| Provider Enumeration Date | 11/04/2018 |
| Last Update Date | 11/04/2018 |
| Medicare PECOS PAC ID | 9133464969 |
|---|---|
| Medicare Enrollment ID | O20181221001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497223846 | NPI | - | NPPES |
| Provider Name | J Dustin Rosenhamer |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1558658138 PECOS PAC ID: 0840463378 Enrollment ID: I20111028000462 |
| Provider Name | Kelli Lea Leek |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1780029603 PECOS PAC ID: 3375785413 Enrollment ID: I20130820000304 |
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