| Grand Lake Medical Park - Monkey Island | |
|
26300 S Highway 125 Afton OK 74331-6282 | |
| (918) 257-8585 | |
| (918) 257-8560 |
| Full Name | Grand Lake Medical Park - Monkey Island |
|---|---|
| Speciality | Clinic/center |
| Location | 26300 S Highway 125, Afton, Oklahoma |
| Authorized Official Name and Position | Herbert F. Crum (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 9182567551 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Lake Medical Park - Monkey Island Po Box 326 Vinita OK 74301-0326 Ph: (918) 256-7551 | Grand Lake Medical Park - Monkey Island 26300 S Highway 125 Afton OK 74331-6282 Ph: (918) 257-8585 |
| NPI Number | 1265602056 |
|---|---|
| Provider Enumeration Date | 03/07/2008 |
| Last Update Date | 03/03/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265602056 | NPI | - | NPPES |
| 100261400K | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2182 (Oklahoma) | Primary |
| 282NR1301X | General Acute Care Hospital - Rural | 2182 (Oklahoma) | Secondary |
Route 66 Health Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 138 S. Main Street, Afton, OK 74331 Phone: 918-257-8029 Fax: 918-257-8042 |