Main Street Family Clinic Aprn-cnp Pllc | |
1201 W Main St Jenks OK 74037-2311 | |
(918) 518-5770 | |
(918) 518-5773 |
Full Name | Main Street Family Clinic Aprn-cnp Pllc |
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Speciality | Clinic/Center |
Location | 1201 W Main St, Jenks, Oklahoma |
Authorized Official Name and Position | Debra Beistle Schroeder (FAMILY NURSE PRACTITIONER) |
Authorized Official Contact | 9185185770 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Main Street Family Clinic Aprn-cnp Pllc 1201 W Main St Jenks OK 74037-2311 Ph: (918) 518-5770 | Main Street Family Clinic Aprn-cnp Pllc 1201 W Main St Jenks OK 74037-2311 Ph: (918) 518-5770 |
NPI Number | 1811321102 |
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Provider Enumeration Date | 08/22/2013 |
Last Update Date | 12/11/2013 |
Medicare PECOS PAC ID | 2163651506 |
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Medicare Enrollment ID | O20140206000814 |
Identifier | Type | State | Issuer |
---|---|---|---|
1811321102 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | R00035175 (Oklahoma) | Primary |
Provider Name | Debra B Schroeder |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932403318 PECOS PAC ID: 1456590595 Enrollment ID: I20130620000304 |
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