| First Choice Wellness Center Llc | |
|
9 N Main Kingston OK 73439-7343 | |
| (158) 056-4050 | |
| (580) 564-0500 |
| Full Name | First Choice Wellness Center Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 9 N Main, Kingston, Oklahoma |
| Authorized Official Name and Position | Addie Beth Gratz (OWNER) |
| Authorized Official Contact | 5803710500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| First Choice Wellness Center Llc Po Box 849 Tishomingo OK 73460-0849 Ph: (580) 564-0500 | First Choice Wellness Center Llc 9 N Main Kingston OK 73439-7343 Ph: (158) 056-4050 |
| NPI Number | 1811187800 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 03/17/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811187800 | NPI | - | NPPES |
| 200117140A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 7588 (Oklahoma) | Primary |
| 364SF0001X | Clinical Nurse Specialist - Family Health | R0067529 (Oklahoma) | Secondary |
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