| |
411 Nw 11th St Oklahoma City OK 73103 | |
(405) 272-0476 | |
(405) 272-0730 |
Full Name | |
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Speciality | Clinic/Center |
Location | 411 Nw 11th St, Oklahoma City, Oklahoma |
Authorized Official Name and Position | Isabella Lawson (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 4057693301 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 30589 Oklahoma City OK 73140 Ph: (405) 769-3301 | 411 Nw 11th St Oklahoma City OK 73103 Ph: (405) 272-0476 |
NPI Number | 1023091519 |
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Provider Enumeration Date | 11/29/2005 |
Last Update Date | 05/22/2020 |
Medicare PECOS PAC ID | 4688584436 |
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Medicare Enrollment ID | O20100819001156 |
Identifier | Type | State | Issuer |
---|---|---|---|
1023091519 | NPI | - | NPPES |
100710520D | Other | OH | MEDICAID CORRECT NUMBER |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Oklahoma Mental Health Council Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4420 N Lincoln Blvd, Oklahoma City, OK 73105 Phone: 405-424-7711 | |
American Current Care P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7100 S I-35 Service Road, Suite 7, Oklahoma City, OK 73149 Phone: 405-632-1002 Fax: 405-632-3131 | |
Oklahoma Pain & Rehab Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2149 Sw 59th St, Suite 201, Oklahoma City, OK 73119 Phone: 405-681-5800 | |
Board Of Regents Of The Univ Of Okla Ou Physicians Employer Spons Clin Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 101 N Robinson Ave, Suite 200, Oklahoma City, OK 73102 Phone: 405-271-8880 Fax: 405-208-8732 | |