Jaiswal Clinic Pllc | |
702 Bryan Dr Suite 100 Durant OK 74701-7031 | |
(580) 924-4704 | |
(580) 924-6001 |
Full Name | Jaiswal Clinic Pllc |
---|---|
Speciality | Internal Medicine |
Location | 702 Bryan Dr, Durant, Oklahoma |
Authorized Official Name and Position | Deepak S Jaiswal (OWNER) |
Authorized Official Contact | 5809244704 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Jaiswal Clinic Pllc Po Box 1514 Durant OK 74702-1514 Ph: (580) 924-4704 | Jaiswal Clinic Pllc 702 Bryan Dr Suite 100 Durant OK 74701-7031 Ph: (580) 924-4704 |
NPI Number | 1225296361 |
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Provider Enumeration Date | 05/27/2008 |
Last Update Date | 02/01/2012 |
Medicare PECOS PAC ID | 4385717586 |
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Medicare Enrollment ID | O20080722000161 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225296361 | NPI | - | NPPES |
1225296361 | Other | GROUP NPI | |
1386698728 | Other | OK | INDIVIDUAL NPI |
200198250A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Deepak Jaiswal |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1386698728 PECOS PAC ID: 9537169743 Enrollment ID: I20070222000743 |
Provider Name | Angela Renee Wright |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1043443062 PECOS PAC ID: 5698805273 Enrollment ID: I20110531000684 |
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