| Healthcare Stat | |
|
1619 S 4th St Chickasha OK 73018-5860 | |
| (405) 224-6700 | |
| (405) 224-6707 |
| Full Name | Healthcare Stat |
|---|---|
| Speciality | Clinic/Center |
| Location | 1619 S 4th St, Chickasha, Oklahoma |
| Authorized Official Name and Position | Shawn P Bonilla (OWNER) |
| Authorized Official Contact | 4054859588 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthcare Stat Po Box 1126 Norman OK 73070-1126 Ph: (405) 659-5656 | Healthcare Stat 1619 S 4th St Chickasha OK 73018-5860 Ph: (405) 224-6700 |
| NPI Number | 1609029644 |
|---|---|
| Provider Enumeration Date | 11/03/2008 |
| Last Update Date | 12/13/2023 |
| Medicare PECOS PAC ID | 7012067762 |
|---|---|
| Medicare Enrollment ID | O20090618000208 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609029644 | NPI | - | NPPES |
| 200226680A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | R0068442 (Oklahoma) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | R0068442 (Oklahoma) | Secondary |
| Provider Name | Hamid Mahmood |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104914985 PECOS PAC ID: 4385608769 Enrollment ID: I20041116000229 |
| Provider Name | Shawn P Bonilla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134213978 PECOS PAC ID: 0244338218 Enrollment ID: I20070614000608 |
| Provider Name | Michele L Lange |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841424991 PECOS PAC ID: 3870631518 Enrollment ID: I20091117000481 |
| Provider Name | Lindsey N Leehan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457760274 PECOS PAC ID: 3870712383 Enrollment ID: I20140916001262 |
| Provider Name | Martin E Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275906844 PECOS PAC ID: 0941581177 Enrollment ID: I20170103000095 |
| Provider Name | Martin Edward Christensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093174708 PECOS PAC ID: 3870870470 Enrollment ID: I20170509001411 |
| Provider Name | Carly Michele Prutzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790235877 PECOS PAC ID: 0446522890 Enrollment ID: I20170818001455 |
| Provider Name | Tonya Kay Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750828356 PECOS PAC ID: 2365714268 Enrollment ID: I20170826000045 |
| Provider Name | Dustin James Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013323336 PECOS PAC ID: 2668718891 Enrollment ID: I20190109002012 |
| Provider Name | Dina Biliske |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417509951 PECOS PAC ID: 5890026074 Enrollment ID: I20191021000881 |
| Provider Name | Kimberly Anne Calhoun |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275019598 PECOS PAC ID: 2961839477 Enrollment ID: I20200224000348 |
| Provider Name | Kayla Ann Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639733595 PECOS PAC ID: 5395176457 Enrollment ID: I20200506000776 |
| Provider Name | Erika Ann Somero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740939990 PECOS PAC ID: 1951780881 Enrollment ID: I20220622003110 |
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