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220 S Mickey Mantle Blvd Commerce OK 74339-2924 | |
(918) 257-8029 | |
(918) 257-8042 |
Full Name | |
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Speciality | Clinic/Center |
Location | 220 S Mickey Mantle Blvd, Commerce, Oklahoma |
Authorized Official Name and Position | Janet Mendez (CEO) |
Authorized Official Contact | 9182578029 |
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 705 Afton OK 74331-0705 Ph: (918) 257-8029 | 220 S Mickey Mantle Blvd Commerce OK 74339-2924 Ph: (918) 257-8029 |
NPI Number | 1699318550 |
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Provider Enumeration Date | 10/23/2019 |
Last Update Date | 01/15/2020 |
Medicare PECOS PAC ID | 9133352081 |
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Medicare Enrollment ID | O20191216000685 |
Identifier | Type | State | Issuer |
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1699318550 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |