| Amc Medical Clinic Llc | |
|
218 N Main St Eufaula OK 74432-1633 | |
| (918) 689-7705 | |
| (855) 860-5341 |
| Full Name | Amc Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 218 N Main St, Eufaula, Oklahoma |
| Authorized Official Name and Position | Brad R Bibb (CEO) |
| Authorized Official Contact | 8708561202 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amc Medical Clinic Llc 4196 Highway 62 412 Ste A Hardy AR 72542-8002 Ph: () - | Amc Medical Clinic Llc 218 N Main St Eufaula OK 74432-1633 Ph: (918) 689-7705 |
| NPI Number | 1295368587 |
|---|---|
| Provider Enumeration Date | 02/15/2020 |
| Last Update Date | 02/09/2021 |
| Medicare PECOS PAC ID | 6901235563 |
|---|---|
| Medicare Enrollment ID | O20200401003332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295368587 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Tina Marie Fort |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033763776 PECOS PAC ID: 8921438581 Enrollment ID: I20200422001157 |
| Provider Name | Mark Hahn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1609895911 PECOS PAC ID: 3375584931 Enrollment ID: I20200427000150 |
| Provider Name | Patricia G Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770060147 PECOS PAC ID: 2365786175 Enrollment ID: I20210111001112 |
| Provider Name | Kendra Danyale Gachathi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770116261 PECOS PAC ID: 0648684266 Enrollment ID: I20210122000124 |
| Provider Name | Morgan Shirley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245752070 PECOS PAC ID: 0547535395 Enrollment ID: I20220317002740 |
| Provider Name | Terri Moody |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750577698 PECOS PAC ID: 3678658473 Enrollment ID: I20231121000551 |
| Provider Name | Debra Sappenfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245000371 PECOS PAC ID: 5991141509 Enrollment ID: I20240306000263 |
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