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19055 State Highway 49 Medicine Park OK 73507 | |
(580) 585-5503 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 19055 State Highway 49, Medicine Park, Oklahoma |
Authorized Official Name and Position | Brent Smith (CEO) |
Authorized Official Contact | 5805855522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3401 W Gore Blvd Lawton OK 73505-6300 Ph: (580) 585-5443 | 19055 State Highway 49 Medicine Park OK 73507 Ph: (580) 585-5503 |
NPI Number | 1124694542 |
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Provider Enumeration Date | 05/27/2021 |
Last Update Date | 12/21/2021 |
Medicare PECOS PAC ID | 2668373689 |
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Medicare Enrollment ID | O20211229001209 |
Identifier | Type | State | Issuer |
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1124694542 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |