Mr Willie J Street, PA-C is a
Physician Assistant based in Tonkawa, Oklahoma. Mr Willie J Street is licensed to practice in Oklahoma (license number 631) and his current practice location is
600 E Grand Ave, Tonkawa, Oklahoma. He can be reached at his office (for appointments etc.) via phone at
(580) 628-4800.
NPI number for Mr Willie J Street is 1215005244 and his current mailing address is Po Box 532, Tonkawa, Oklahoma. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1215005244.
Provider's Profile
| Full Name | Mr Willie J Street |
|---|
| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 600 E Grand Ave, Tonkawa, Oklahoma |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1215005244
- Provider Enumeration Date: 11/30/2006
- Last Update Date: 03/07/2012
Medical Identifiers
Medical identifiers for Mr Willie J Street such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1215005244 | NPI | - | NPPES |
| 100101960G | Medicaid | OK | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 631 (Oklahoma) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Willie J Street is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Willie J Street, PA-C
Po Box 532,
Tonkawa, OK 74653-0532
Ph: (580) 628-4800 | Mr Willie J Street, PA-C
600 E Grand Ave,
Tonkawa, OK 74653-3545
Ph: (580) 628-4800 |
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