Full Name | |
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Speciality | Family Medicine |
Location | 823 D St, Snyder, Oklahoma |
Authorized Official Name and Position | Brent Smith (CFO) |
Authorized Official Contact | 5803558620 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 785 Lawton OK 73502-0785 Ph: (580) 357-9984 | 823 D St Snyder OK 73566-2031 Ph: (580) 569-2373 |
NPI Number | 1790702579 |
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Provider Enumeration Date | 07/16/2006 |
Last Update Date | 05/08/2015 |
Medicare PECOS PAC ID | 2668373689 |
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Medicare Enrollment ID | O20080730000044 |
Identifier | Type | State | Issuer |
---|---|---|---|
1790702579 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 20057 (Oklahoma) | Primary |