| Mary Mahoney Memorial Health Center | |
|
12716 Ne 36th St Oklahoma City OK 73140-0000 | |
| (405) 769-3301 | |
| (405) 769-9685 |
| Full Name | Mary Mahoney Memorial Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 12716 Ne 36th St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Isabella Lawson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4057693301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Mahoney Memorial Health Center Po Box 30589 Midwest City OK 73140 Ph: (405) 769-3301 | Mary Mahoney Memorial Health Center 12716 Ne 36th St Oklahoma City OK 73140-0000 Ph: (405) 769-3301 |
| NPI Number | 1265415806 |
|---|---|
| Provider Enumeration Date | 11/29/2005 |
| Last Update Date | 01/17/2024 |
| Medicare PECOS PAC ID | 4688584436 |
|---|---|
| Medicare Enrollment ID | O20060914000328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265415806 | NPI | - | NPPES |
| 100709120B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Michael W Goddard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285665109 PECOS PAC ID: 5698670925 Enrollment ID: I20031201000425 |
| Provider Name | Febi Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548244650 PECOS PAC ID: 6103899059 Enrollment ID: I20040818000453 |
| Provider Name | Vivian L Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386753945 PECOS PAC ID: 1355385014 Enrollment ID: I20050614000233 |
| Provider Name | Don Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1083655021 PECOS PAC ID: 0143110056 Enrollment ID: I20050930000449 |
| Provider Name | Liji T Seilas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003072430 PECOS PAC ID: 8325187008 Enrollment ID: I20091209000666 |
| Provider Name | Priya P Samant |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114901204 PECOS PAC ID: 6901935691 Enrollment ID: I20100518000426 |
| Provider Name | Amy S Moore |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1801010095 PECOS PAC ID: 5092876656 Enrollment ID: I20101021001016 |
| Provider Name | Bethany Carolee Rollins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215282132 PECOS PAC ID: 2062661010 Enrollment ID: I20121005000641 |
| Provider Name | Anita R Blick-nolan |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992766976 PECOS PAC ID: 8325283377 Enrollment ID: I20130323000043 |
| Provider Name | Allie S Simon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205224482 PECOS PAC ID: 8224354964 Enrollment ID: I20150224001234 |
| Provider Name | Jodi Jenista |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104205186 PECOS PAC ID: 6800107301 Enrollment ID: I20150625000639 |
| Provider Name | April J Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154758530 PECOS PAC ID: 2466764493 Enrollment ID: I20150706001810 |
| Provider Name | Megan K Ballas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245632884 PECOS PAC ID: 4385966258 Enrollment ID: I20151026000430 |
| Provider Name | Tierra J Page |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487015475 PECOS PAC ID: 3577841956 Enrollment ID: I20161107000920 |
| Provider Name | Fred Loper |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1700903093 PECOS PAC ID: 1456631241 Enrollment ID: I20161214000391 |
| Provider Name | Shijy Joykutty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457899841 PECOS PAC ID: 0446528202 Enrollment ID: I20170620000758 |
| Provider Name | Martine Ngamelue-kouemo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568910966 PECOS PAC ID: 6002166089 Enrollment ID: I20180912003378 |
| Provider Name | April Ajanwachukwu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1649631409 PECOS PAC ID: 5890039465 Enrollment ID: I20181208000087 |
| Provider Name | Cynthia Guerrero Del Rosario |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568939395 PECOS PAC ID: 8325383110 Enrollment ID: I20181226000975 |
| Provider Name | Kristi Hlubek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962818328 PECOS PAC ID: 3971925876 Enrollment ID: I20200623001776 |
| Provider Name | Daniel Way-en Shen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194252775 PECOS PAC ID: 7012332976 Enrollment ID: I20200810001068 |
| Provider Name | Betsy A Mathew |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639779986 PECOS PAC ID: 9931516341 Enrollment ID: I20210401000248 |
| Provider Name | Craig Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033725205 PECOS PAC ID: 4486053626 Enrollment ID: I20210520001718 |
| Provider Name | Tanya R. Cates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629699244 PECOS PAC ID: 1658776430 Enrollment ID: I20210817001091 |
| Provider Name | Gauri Ajit Ghate |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851881924 PECOS PAC ID: 7719382472 Enrollment ID: I20210819000676 |
| Provider Name | Stacey Lynn Lowery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528608551 PECOS PAC ID: 3779959978 Enrollment ID: I20221012003668 |
| Provider Name | Allison Kay Griffiths |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376912600 PECOS PAC ID: 0143673004 Enrollment ID: I20240126001222 |
| Provider Name | Shawntay Alexander |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912257882 PECOS PAC ID: 7517310196 Enrollment ID: I20240131000334 |
| Provider Name | Ginette Tchiengang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073985172 PECOS PAC ID: 4486097011 Enrollment ID: I20240209003197 |
| Provider Name | Rocksand Mace |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1881959385 PECOS PAC ID: 6800230467 Enrollment ID: I20240222001027 |
Oklahoma Mental Health Council Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4420 N Lincoln Blvd, Oklahoma City, OK 73105 Phone: 405-424-7711 | |
American Current Care P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7100 S I-35 Service Road, Suite 7, Oklahoma City, OK 73149 Phone: 405-632-1002 Fax: 405-632-3131 | |
St Anthony Primary Care Physicians North Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6201 N Santa Fe Ave, Suite 2020, Oklahoma City, OK 73118 Phone: 405-272-5433 Fax: 405-272-5435 | |
Oklahoma Pain & Rehab Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2149 Sw 59th St, Suite 201, Oklahoma City, OK 73119 Phone: 405-681-5800 | |
Board Of Regents Of The Univ Of Okla Ou Physicians Employer Spons Clin Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 N Robinson Ave, Suite 200, Oklahoma City, OK 73102 Phone: 405-271-8880 Fax: 405-208-8732 | |
St Anthony North Urgent Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6201 N Santa Fe Ave, Suite 1010, Oklahoma City, OK 73118 Phone: 405-772-8687 Fax: 405-772-8688 | |
Barreto Health Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3418 Nw 135th St, Oklahoma City, OK 73120 Phone: 405-286-1075 Fax: 405-608-1075 |