| Ellis Family Practice | |
|
420 N Kickapoo Ave Shawnee OK 74801-6643 | |
| (400) 581-6331 | |
| Not Available |
| Full Name | Ellis Family Practice |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 420 N Kickapoo Ave, Shawnee, Oklahoma |
| Authorized Official Name and Position | Denise Cato (CONTRACTING MANAGER) |
| Authorized Official Contact | 4054701884 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Family Practice 5909 Nw Expressway Ste 360 Oklahoma City OK 73132-5149 Ph: (405) 470-1884 | Ellis Family Practice 420 N Kickapoo Ave Shawnee OK 74801-6643 Ph: (400) 581-6331 |
| NPI Number | 1538672001 |
|---|---|
| Provider Enumeration Date | 11/07/2017 |
| Last Update Date | 11/07/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538672001 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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