| |
1013 Dewey Ave Poteau OK 74953-4409 | |
(918) 647-2929 | |
(918) 647-2288 |
Full Name | |
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Speciality | Family Medicine |
Location | 1013 Dewey Ave, Poteau, Oklahoma |
Authorized Official Name and Position | Robert L Carter (CEO) |
Authorized Official Contact | 9186353441 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1013 Dewey Ave Poteau OK 74953-4409 Ph: (918) 647-2929 | 1013 Dewey Ave Poteau OK 74953-4409 Ph: (918) 647-2929 |
NPI Number | 1578026571 |
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Provider Enumeration Date | 04/08/2019 |
Last Update Date | 10/22/2019 |
Medicare PECOS PAC ID | 7719916956 |
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Medicare Enrollment ID | O20200113000839 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578026571 | NPI | - | NPPES |
513012 | Medicaid | OK |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Secondary |
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