Charger Health Group Pllc | |
511 N Aspen Ave Broken Arrow OK 74012-2220 | |
(918) 806-8050 | |
(918) 806-8090 |
Full Name | Charger Health Group Pllc |
---|---|
Speciality | Family Medicine |
Location | 511 N Aspen Ave, Broken Arrow, Oklahoma |
Authorized Official Name and Position | Dennis S Blackstad (OWNER) |
Authorized Official Contact | 9186056582 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Charger Health Group Pllc Po Box 342 Broken Arrow OK 74013-0342 Ph: (918) 605-6582 | Charger Health Group Pllc 511 N Aspen Ave Broken Arrow OK 74012-2220 Ph: (918) 806-8050 |
NPI Number | 1346855640 |
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Provider Enumeration Date | 09/14/2020 |
Last Update Date | 09/22/2020 |
Medicare PECOS PAC ID | 0941610240 |
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Medicare Enrollment ID | O20201027002200 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346855640 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Dennis S Blackstad |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1710040894 PECOS PAC ID: 3678526969 Enrollment ID: I20050228000026 |
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