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428 E 10th St 429 E. 10th St Ada OK 74820-5221 | |
| (580) 310-9755 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 428 E 10th St, Ada, Oklahoma |
| Authorized Official Name and Position | Jason Hale (PRES) |
| Authorized Official Contact | 5803109755 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
428 E 10th St 429 E 10th St Ada OK 74820-5221 Ph: (580) 310-9755 | 428 E 10th St 429 E. 10th St Ada OK 74820-5221 Ph: (580) 310-9755 |
| NPI Number | 1114126711 |
|---|---|
| Provider Enumeration Date | 07/13/2007 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114126711 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2538 (Oklahoma) | Primary |
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