| Great Plains Pat Wall Clinic | |
|
1800 W 1st St Suites 101, 102, 103 And 105 Elk City OK 73644-3133 | |
| (580) 225-2515 | |
| (580) 303-5850 |
| Full Name | Great Plains Pat Wall Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1800 W 1st St, Elk City, Oklahoma |
| Authorized Official Name and Position | Corey Lively (CEO) |
| Authorized Official Contact | 5808215300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Plains Pat Wall Clinic Po Box 2339 Elk City OK 73648-2339 Ph: (580) 225-2511 | Great Plains Pat Wall Clinic 1800 W 1st St Suites 101, 102, 103 And 105 Elk City OK 73644-3133 Ph: (580) 225-2515 |
| NPI Number | 1114421492 |
|---|---|
| Provider Enumeration Date | 03/21/2018 |
| Last Update Date | 05/10/2018 |
| Medicare PECOS PAC ID | 7517949415 |
|---|---|
| Medicare Enrollment ID | O20180626001112 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114421492 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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