Full Name | |
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Speciality | Clinic/Center |
Location | 103 E Main, Beggs, Oklahoma |
Authorized Official Name and Position | Kerri Lee Ellis (OWNER/ADMINISTRATOR) |
Authorized Official Contact | 9183670010 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 478 Beggs OK 74421-0478 Ph: (918) 267-7000 | 103 E Main Beggs OK 74421-0478 Ph: (918) 267-7000 |
NPI Number | 1497766000 |
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Provider Enumeration Date | 08/10/2006 |
Last Update Date | 09/30/2021 |
Medicare PECOS PAC ID | 6507903630 |
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Medicare Enrollment ID | O20091028000222 |
Identifier | Type | State | Issuer |
---|---|---|---|
1497766000 | NPI | - | NPPES |
100708410B | Medicaid | OK |
Provider Name | Kerri L Ellis |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1447409206 PECOS PAC ID: 2163569971 Enrollment ID: I20091030000187 |