| |
1308 E Carl Albert Pkwy Mcalester OK 74501-5236 | |
(918) 423-7191 | |
(918) 426-7625 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1308 E Carl Albert Pkwy, Mcalester, Oklahoma |
Authorized Official Name and Position | Trent Bourland (CEO) |
Authorized Official Contact | 5809272327 |
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 326 Coalgate OK 74538-0326 Ph: (580) 927-2327 | 1308 E Carl Albert Pkwy Mcalester OK 74501-5236 Ph: (918) 423-7191 |
NPI Number | 1245938497 |
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Provider Enumeration Date | 02/17/2023 |
Last Update Date | 12/13/2024 |
Medicare PECOS PAC ID | 8022901396 |
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Medicare Enrollment ID | O20180731001666 |
Identifier | Type | State | Issuer |
---|---|---|---|
1245938497 | NPI | - | NPPES |
100774650I | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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