| Grand Lake Medical And Wellness Corp | |
|
101 W Quesenbury Ave Sallisaw OK 74955-3613 | |
| (918) 235-6877 | |
| Not Available |
| Full Name | Grand Lake Medical And Wellness Corp |
|---|---|
| Speciality | Clinic/center - Pain |
| Location | 101 W Quesenbury Ave, Sallisaw, Oklahoma |
| Authorized Official Name and Position | Serena B Wilson (OWNER) |
| Authorized Official Contact | 9189611658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lake Medical And Wellness Corp 58700 E 190 Rd Fairland OK 74343-2500 Ph: () - | Grand Lake Medical And Wellness Corp 101 W Quesenbury Ave Sallisaw OK 74955-3613 Ph: (918) 235-6877 |
| NPI Number | 1336706118 |
|---|---|
| Provider Enumeration Date | 05/28/2019 |
| Last Update Date | 05/28/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336706118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Primary |
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