| Arbuckle Family Clinic | |
|
2011 W Broadway Ave Sulphur OK 73086 | |
| (580) 622-4482 | |
| (580) 622-5509 |
| Full Name | Arbuckle Family Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 2011 W Broadway Ave, Sulphur, Oklahoma |
| Authorized Official Name and Position | Jeremy Jones (CEO) |
| Authorized Official Contact | 5806222161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Arbuckle Family Clinic Po Box 1109 Sulphur OK 73086-8109 Ph: (580) 622-4482 | Arbuckle Family Clinic 2011 W Broadway Ave Sulphur OK 73086 Ph: (580) 622-4482 |
| NPI Number | 1730541673 |
|---|---|
| Provider Enumeration Date | 03/21/2016 |
| Last Update Date | 11/25/2019 |
| Medicare PECOS PAC ID | 0840104956 |
|---|---|
| Medicare Enrollment ID | O20031113000508 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730541673 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Oklahoma) | Primary |
| Provider Name | Teresa J Lynn |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265475735 PECOS PAC ID: 0446224984 Enrollment ID: I20040821000153 |
| Provider Name | William K Tordzro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780688317 PECOS PAC ID: 7911892302 Enrollment ID: I20090127000318 |
| Provider Name | Ryan W Oden |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659538734 PECOS PAC ID: 3870659568 Enrollment ID: I20090304000629 |
| Provider Name | Brenda K Winters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821221771 PECOS PAC ID: 2668657743 Enrollment ID: I20110505000320 |
| Provider Name | George Russell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508307448 PECOS PAC ID: 6800168766 Enrollment ID: I20171006000867 |
| Provider Name | Stacey Lynn Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225556681 PECOS PAC ID: 3173883287 Enrollment ID: I20180212000587 |
| Provider Name | Tyger Michelle Freeman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902324262 PECOS PAC ID: 3577823509 Enrollment ID: I20180212001620 |
| Provider Name | Austin Tanner Brookover |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1114447984 PECOS PAC ID: 8022353721 Enrollment ID: I20190909003872 |
| Provider Name | Dillon P Pryor |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316501992 PECOS PAC ID: 0941626774 Enrollment ID: I20200811002972 |
| Provider Name | Chet D Wilson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770146607 PECOS PAC ID: 7911324330 Enrollment ID: I20200831003384 |
| Provider Name | Stephanie Michelle Hammons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124648746 PECOS PAC ID: 6103245386 Enrollment ID: I20201008000430 |
| Provider Name | Natalie N Siegfried |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1457960247 PECOS PAC ID: 7214331818 Enrollment ID: I20210804001150 |
| Provider Name | Ethan Jernigan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790305456 PECOS PAC ID: 4183029184 Enrollment ID: I20210827002856 |
| Provider Name | Jeremiah Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992369037 PECOS PAC ID: 2264829068 Enrollment ID: I20220426001519 |
| Provider Name | Candice Nichole Woods |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083351894 PECOS PAC ID: 7113300260 Enrollment ID: I20221117000789 |
| Provider Name | Mahmoud Alnsour |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467193003 PECOS PAC ID: 9638532013 Enrollment ID: I20230927002235 |
| Provider Name | Tony G Wallen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932720349 PECOS PAC ID: 7517365794 Enrollment ID: I20240214000427 |
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