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310 E. Walnut Street Canton OK 73724 | |
(580) 596-2800 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 310 E. Walnut Street, Canton, Oklahoma |
Authorized Official Name and Position | Tim Starkey (CEO) |
Authorized Official Contact | 5805962800 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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405 S Oklahoma Ave Cherokee OK 73728-2545 Ph: () - | 310 E. Walnut Street Canton OK 73724 Ph: (580) 596-2800 |
NPI Number | 1427593409 |
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Provider Enumeration Date | 12/29/2016 |
Last Update Date | 07/03/2023 |
Medicare PECOS PAC ID | 9133201171 |
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Medicare Enrollment ID | O20170517000762 |
Identifier | Type | State | Issuer |
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1427593409 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |