| N/a | |
|
2420 Springer Dr Suite 215 Norman OK 73069-3965 | |
| (405) 366-6068 | |
| (405) 366-6281 |
| Full Name | N/a |
|---|---|
| Speciality | Social Worker |
| Location | 2420 Springer Dr, Norman, Oklahoma |
| Authorized Official Name and Position | Martha Rachelle Hardin-moniz (PRESIDENT) |
| Authorized Official Contact | 4053666068 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a Po Box 5423 Norman OK 73070-5423 Ph: (405) 366-6068 | N/a 2420 Springer Dr Suite 215 Norman OK 73069-3965 Ph: (405) 366-6068 |
| NPI Number | 1972790780 |
|---|---|
| Provider Enumeration Date | 09/26/2007 |
| Last Update Date | 09/26/2007 |
| Medicare PECOS PAC ID | 7618921719 |
|---|---|
| Medicare Enrollment ID | O20050506000392 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972790780 | NPI | - | NPPES |
| 200105400A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1025 (Oklahoma) | Primary |
| Provider Name | Martha Rachelle Hardin-moniz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376609438 PECOS PAC ID: 7719931807 Enrollment ID: I20050513000370 |
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