| Edmond Physician Services Llc | |
|
105 S Bryant Ave Ste 105 Edmond OK 73034-6330 | |
| (405) 715-3102 | |
| Not Available |
| Full Name | Edmond Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 105 S Bryant Ave Ste 105, Edmond, Oklahoma |
| Authorized Official Name and Position | Stephanie Jones (DIRECTOR OF PATIENT ACCOUNTING) |
| Authorized Official Contact | 4052718132 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edmond Physician Services Llc Po Box 744503 Atlanta GA 30374-4503 Ph: (405) 271-8132 | Edmond Physician Services Llc 105 S Bryant Ave Ste 105 Edmond OK 73034-6330 Ph: (405) 715-3102 |
| NPI Number | 1629018429 |
|---|---|
| Provider Enumeration Date | 06/08/2006 |
| Last Update Date | 03/11/2019 |
| Medicare PECOS PAC ID | 4284683954 |
|---|---|
| Medicare Enrollment ID | O20050120000069 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629018429 | NPI | - | NPPES |
| 200045590A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Maroun M Tawk |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1255300927 PECOS PAC ID: 5698712784 Enrollment ID: I20050411000663 |
| Provider Name | Michael S Hull |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1396891743 PECOS PAC ID: 3072533926 Enrollment ID: I20051229000162 |
| Provider Name | Tarek A Dernaika |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1639220437 PECOS PAC ID: 0941307664 Enrollment ID: I20070515000131 |
| Provider Name | Jeremy B Moad |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1134325608 PECOS PAC ID: 0244411767 Enrollment ID: I20110216000843 |
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