| Express Family Care Llc | |
|
7117 W. Wilshire Blvd Oklahoma City OK 73132 | |
| (405) 470-1224 | |
| (405) 217-0063 |
| Full Name | Express Family Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7117 W. Wilshire Blvd, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Jimmy Lee Tisdale (OWNER) |
| Authorized Official Contact | 4054701224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Express Family Care Llc 7117 W Wilshire Blvd Oklahoma City OK 73132-5575 Ph: (405) 470-1224 | Express Family Care Llc 7117 W. Wilshire Blvd Oklahoma City OK 73132 Ph: (405) 470-1224 |
| NPI Number | 1861873085 |
|---|---|
| Provider Enumeration Date | 06/12/2015 |
| Last Update Date | 02/13/2020 |
| Medicare PECOS PAC ID | 3072820885 |
|---|---|
| Medicare Enrollment ID | O20150910002607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861873085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | F0613916 (Oklahoma) | Primary |
| Provider Name | Jimmy L Tisdale |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477992253 PECOS PAC ID: 0446494397 Enrollment ID: I20130917000133 |
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