| Sooner Psychiatry Pllc | |
|
1218 E 9th St Ste 1 Edmond OK 73034-5796 | |
| (405) 896-6777 | |
| (405) 896-6725 |
| Full Name | Sooner Psychiatry Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1218 E 9th St Ste 1, Edmond, Oklahoma |
| Authorized Official Name and Position | Ahmed Refat Abdelaziz (PRESIDENT) |
| Authorized Official Contact | 4059260444 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sooner Psychiatry Pllc 1218 E 9th St Ste 1 Edmond OK 73034-5796 Ph: (405) 896-6777 | Sooner Psychiatry Pllc 1218 E 9th St Ste 1 Edmond OK 73034-5796 Ph: (405) 896-6777 |
| NPI Number | 1689921207 |
|---|---|
| Provider Enumeration Date | 08/14/2012 |
| Last Update Date | 01/17/2018 |
| Medicare PECOS PAC ID | 6709108558 |
|---|---|
| Medicare Enrollment ID | O20141204002014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689921207 | NPI | - | NPPES |
| 200560830A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 26276 (Oklahoma) | Primary |
| Provider Name | Ahmed M Refat Abdelaziz |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1467615765 PECOS PAC ID: 1658535588 Enrollment ID: I20120605000705 |
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