Full Name | |
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Speciality | Clinic/Center |
Location | 512 W C Ave, Cache, Oklahoma |
Authorized Official Name and Position | Brent Smith (CEO) |
Authorized Official Contact | 5805855522 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3401 W Gore Blvd Lawton OK 73505-6332 Ph: (580) 585-5511 | 512 W C Ave Cache OK 73527-9491 Ph: (580) 699-7355 |
NPI Number | 1285294298 |
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Provider Enumeration Date | 06/20/2019 |
Last Update Date | 09/02/2020 |
Medicare PECOS PAC ID | 2668373689 |
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Medicare Enrollment ID | O20190719000794 |
Identifier | Type | State | Issuer |
---|---|---|---|
1285294298 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |