Jcmh Pediatric Clinic | |
101 S Park Ln Suite 100 Altus OK 73521-5731 | |
(580) 379-6100 | |
(580) 379-6109 |
Full Name | Jcmh Pediatric Clinic |
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Speciality | Clinic/Center |
Location | 101 S Park Ln, Altus, Oklahoma |
Authorized Official Name and Position | Steve Hartgraves (PRESIDENT/CEO) |
Authorized Official Contact | 5803795500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Jcmh Pediatric Clinic 1200 E Pecan St Altus OK 73521-6141 Ph: (580) 379-5000 | Jcmh Pediatric Clinic 101 S Park Ln Suite 100 Altus OK 73521-5731 Ph: (580) 379-6100 |
NPI Number | 1407230790 |
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Provider Enumeration Date | 07/16/2015 |
Last Update Date | 10/06/2022 |
Medicare PECOS PAC ID | 1759293178 |
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Medicare Enrollment ID | O20150922000568 |
Identifier | Type | State | Issuer |
---|---|---|---|
1407230790 | NPI | - | NPPES |
200688750A | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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