Cornerstone Family Medicine Pllc | |
4902 Oklahoma Ave Woodward OK 73801-3713 | |
(580) 254-5316 | |
(580) 254-0130 |
Full Name | Cornerstone Family Medicine Pllc |
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Speciality | Family Medicine |
Location | 4902 Oklahoma Ave, Woodward, Oklahoma |
Authorized Official Name and Position | Keenan Ferguson (OWNER/PHYSICIAN) |
Authorized Official Contact | 5802545316 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Cornerstone Family Medicine Pllc 3100 Downs Ave Woodward OK 73801-5328 Ph: (580) 254-5316 | Cornerstone Family Medicine Pllc 4902 Oklahoma Ave Woodward OK 73801-3713 Ph: (580) 254-5316 |
NPI Number | 1376257832 |
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Provider Enumeration Date | 01/10/2023 |
Last Update Date | 01/10/2023 |
Medicare PECOS PAC ID | 6406221159 |
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Medicare Enrollment ID | O20230411000843 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376257832 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Keenan L Ferguson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1154309466 PECOS PAC ID: 0446227151 Enrollment ID: I20061003000374 |
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