Hometown Primary Care, Pllc | |
13511 Ne 23rd St Ste 140 Choctaw OK 73020-8625 | |
(405) 591-3584 | |
(405) 337-9596 |
Full Name | Hometown Primary Care, Pllc |
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Speciality | Clinic/Center |
Location | 13511 Ne 23rd St Ste 140, Choctaw, Oklahoma |
Authorized Official Name and Position | Candace D Herrin (MEMBER/NURSE PRACTITIONER) |
Authorized Official Contact | 4055913584 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Hometown Primary Care, Pllc 890 S Sandpiper Nest Choctaw OK 73020-7012 Ph: (405) 625-3873 | Hometown Primary Care, Pllc 13511 Ne 23rd St Ste 140 Choctaw OK 73020-8625 Ph: (405) 591-3584 |
NPI Number | 1942945910 |
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Provider Enumeration Date | 05/03/2022 |
Last Update Date | 05/03/2022 |
Medicare PECOS PAC ID | 0547638918 |
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Medicare Enrollment ID | O20221116002912 |
Identifier | Type | State | Issuer |
---|---|---|---|
1942945910 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Candace Herrin |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1114544871 PECOS PAC ID: 2163846908 Enrollment ID: I20200727000797 |
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