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102 South Ellis Boise City OK 73933-1059 | |
(580) 544-3008 | |
(580) 544-3066 |
Full Name | |
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Speciality | Clinic/Center |
Location | 102 South Ellis, Boise City, Oklahoma |
Authorized Official Name and Position | Jonathan W Gleason (CEO) |
Authorized Official Contact | 5805890231 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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102 S Ellis Boise City OK 73933-1059 Ph: (580) 544-2501 | 102 South Ellis Boise City OK 73933-1059 Ph: (580) 544-3008 |
NPI Number | 1679543581 |
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Provider Enumeration Date | 01/24/2006 |
Last Update Date | 06/29/2023 |
Medicare PECOS PAC ID | 5698686517 |
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Medicare Enrollment ID | O20030715000024 |
Identifier | Type | State | Issuer |
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1679543581 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 2254 (Oklahoma) | Primary |