| Bryant Street Family Medicine, P.c. | |
|
305 South Bryant Ave 110 Edmond OK 73034 | |
| (405) 513-7333 | |
| (405) 513-7337 |
| Full Name | Bryant Street Family Medicine, P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 305 South Bryant Ave, Edmond, Oklahoma |
| Authorized Official Name and Position | Chesca Nicole Craig-goodell (PHYSICIAN) |
| Authorized Official Contact | 4055137333 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bryant Street Family Medicine, P.c. 305 South Bryant Ave 110 Edmond OK 73034 Ph: (405) 513-7333 | Bryant Street Family Medicine, P.c. 305 South Bryant Ave 110 Edmond OK 73034 Ph: (405) 513-7333 |
| NPI Number | 1396909446 |
|---|---|
| Provider Enumeration Date | 07/17/2008 |
| Last Update Date | 11/01/2016 |
| Medicare PECOS PAC ID | 4981768819 |
|---|---|
| Medicare Enrollment ID | O20090121000566 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396909446 | NPI | - | NPPES |
| 1366510802 | Other | OK | INDIVIDUAL PROVIDER NPI NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Oklahoma) | Primary |
| Provider Name | Chesca N Craig-goodell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366510802 PECOS PAC ID: 4082638549 Enrollment ID: I20071129000716 |
| Provider Name | Kasondra Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982298196 PECOS PAC ID: 4183012404 Enrollment ID: I20211019001538 |
| Provider Name | Anny Lou Mandapat Dunham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194368316 PECOS PAC ID: 3476926015 Enrollment ID: I20230302001307 |
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