| Stillwater Neurology, Llc | |
|
1201 S Adams St Stillwater OK 74074-5476 | |
| (405) 533-2060 | |
| Not Available |
| Full Name | Stillwater Neurology, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1201 S Adams St, Stillwater, Oklahoma |
| Authorized Official Name and Position | John Wedlake (OWNER) |
| Authorized Official Contact | 4055332060 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stillwater Neurology, Llc 1201 S Adams St Stillwater OK 74074-5476 Ph: (405) 533-2060 | Stillwater Neurology, Llc 1201 S Adams St Stillwater OK 74074-5476 Ph: (405) 533-2060 |
| NPI Number | 1538542618 |
|---|---|
| Provider Enumeration Date | 07/07/2015 |
| Last Update Date | 05/04/2017 |
| Medicare PECOS PAC ID | 2860708260 |
|---|---|
| Medicare Enrollment ID | O20150831002460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538542618 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | John R Wedlake |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1215221478 PECOS PAC ID: 6709192115 Enrollment ID: I20150831002863 |
| Provider Name | David Mccoy |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1477847416 PECOS PAC ID: 0244546653 Enrollment ID: I20151008003010 |
| Provider Name | Amy K Alberty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598223851 PECOS PAC ID: 4981946779 Enrollment ID: I20190426000726 |
| Provider Name | Ashley S Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780099614 PECOS PAC ID: 1850611633 Enrollment ID: I20200922002940 |
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