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2820 N Kelly Ave Suite 200 Edmond OK 73003-3007 | |
| (405) 330-1478 | |
| (405) 330-6231 |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 2820 N Kelly Ave, Edmond, Oklahoma |
| Authorized Official Name and Position | Timothy Brian Jones (OWNER) |
| Authorized Official Contact | 4053301478 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 31266 Edmond OK 73003-0022 Ph: (405) 330-1478 | 2820 N Kelly Ave Suite 200 Edmond OK 73003-3007 Ph: (405) 330-1478 |
| NPI Number | 1699963264 |
|---|---|
| Provider Enumeration Date | 10/09/2007 |
| Last Update Date | 02/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699963264 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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