| Air Depot Family Medicine | |
|
1721 S Air Depot Blvd Midwest City OK 73110-5103 | |
| (405) 610-2447 | |
| (405) 610-2086 |
| Full Name | Air Depot Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1721 S Air Depot Blvd, Midwest City, Oklahoma |
| Authorized Official Name and Position | Tyson Dinh Quy (PHYSICIAN) |
| Authorized Official Contact | 4056102447 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Air Depot Family Medicine 1721 S Air Depot Blvd Midwest City OK 73110-5103 Ph: (405) 610-2447 | Air Depot Family Medicine 1721 S Air Depot Blvd Midwest City OK 73110-5103 Ph: (405) 610-2447 |
| NPI Number | 1497012017 |
|---|---|
| Provider Enumeration Date | 04/19/2012 |
| Last Update Date | 10/31/2015 |
| Medicare PECOS PAC ID | 3072737378 |
|---|---|
| Medicare Enrollment ID | O20140606000173 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497012017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 25749 (Oklahoma) | Primary |
| Provider Name | Tyson D Quy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1447453071 PECOS PAC ID: 6204980410 Enrollment ID: I20090821000193 |
| Provider Name | Soisangvane Wingard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922370899 PECOS PAC ID: 6507020989 Enrollment ID: I20120614000793 |
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