| House Calls Direct Pllc | |
|
415 W Gore Blvd Lawton OK 73501-3710 | |
| (580) 248-9966 | |
| Not Available |
| Full Name | House Calls Direct Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 415 W Gore Blvd, Lawton, Oklahoma |
| Authorized Official Name and Position | Mary Anne Derrico (APRN/CO-OWNER) |
| Authorized Official Contact | 5805120746 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| House Calls Direct Pllc 415 W Gore Blvd Lawton OK 73501-3710 Ph: (580) 248-9966 | House Calls Direct Pllc 415 W Gore Blvd Lawton OK 73501-3710 Ph: (580) 248-9966 |
| NPI Number | 1548875545 |
|---|---|
| Provider Enumeration Date | 09/15/2020 |
| Last Update Date | 09/15/2020 |
| Medicare PECOS PAC ID | 2365854544 |
|---|---|
| Medicare Enrollment ID | O20201211000689 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548875545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Mary A. Derrico |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245581974 PECOS PAC ID: 7810134582 Enrollment ID: I20130516000637 |
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