| Ebenezer Healthcare Services, | |
|
10444 Greenbriar Place Suite C Oklahoma City OK 73159-7660 | |
| (405) 378-2119 | |
| (405) 759-7022 |
| Full Name | Ebenezer Healthcare Services, |
|---|---|
| Speciality | Clinic/Center |
| Location | 10444 Greenbriar Place, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Maria Agnes E Smith (CEO) |
| Authorized Official Contact | 4053782119 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ebenezer Healthcare Services, 10444 Greenbriar Place, Suite C Oklahoma City OK 73159-7660 Ph: (405) 378-2119 | Ebenezer Healthcare Services, 10444 Greenbriar Place Suite C Oklahoma City OK 73159-7660 Ph: (405) 378-2119 |
| NPI Number | 1770766610 |
|---|---|
| Provider Enumeration Date | 12/14/2007 |
| Last Update Date | 05/25/2010 |
| Medicare PECOS PAC ID | 6406983022 |
|---|---|
| Medicare Enrollment ID | O20100429000853 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770766610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Maria Agnes E Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386674125 PECOS PAC ID: 8325088008 Enrollment ID: I20050517001074 |
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