| Innovative Medical Associates Pllc | |
|
4301 Nw 63rd St Suite 205 Oklahoma City OK 73116-1549 | |
| (405) 242-6494 | |
| (405) 242-6496 |
| Full Name | Innovative Medical Associates Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4301 Nw 63rd St, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Vatsala Shah (MANAGING PARTNER) |
| Authorized Official Contact | 4055531540 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Medical Associates Pllc 1225 W Main St Suite 205 Norman OK 73069-6824 Ph: (405) 292-5500 | Innovative Medical Associates Pllc 4301 Nw 63rd St Suite 205 Oklahoma City OK 73116-1549 Ph: (405) 242-6494 |
| NPI Number | 1407066228 |
|---|---|
| Provider Enumeration Date | 05/23/2007 |
| Last Update Date | 01/07/2016 |
| Medicare PECOS PAC ID | 6800923665 |
|---|---|
| Medicare Enrollment ID | O20100427000610 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407066228 | NPI | - | NPPES |
| 100748720A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Vatsala N Shah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376535328 PECOS PAC ID: 3779610530 Enrollment ID: I20100427000660 |
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