| Olive Branch Clinic | |
|
13821 Technology Dr Ste B Oklahoma City OK 73134-1046 | |
| (405) 451-3454 | |
| (405) 451-3454 |
| Full Name | Olive Branch Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 13821 Technology Dr Ste B, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | William Oliva (CHIEF MEDICAL OFFICER) |
| Authorized Official Contact | 4054513454 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Branch Clinic 13821 Technology Dr Ste B Oklahoma City OK 73134-1046 Ph: (405) 451-3454 | Olive Branch Clinic 13821 Technology Dr Ste B Oklahoma City OK 73134-1046 Ph: (405) 451-3454 |
| NPI Number | 1528512183 |
|---|---|
| Provider Enumeration Date | 08/11/2016 |
| Last Update Date | 10/04/2022 |
| Certification Date | 12/01/2020 |
| Medicare PECOS PAC ID | 0042598567 |
|---|---|
| Medicare Enrollment ID | O20161103000121 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528512183 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Primary |
| Provider Name | William Oliva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356781199 PECOS PAC ID: 5991025850 Enrollment ID: I20161028000688 |
| Provider Name | Tayyaba Ali |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700292356 PECOS PAC ID: 4981968492 Enrollment ID: I20180509003021 |
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