| Meridian Long Term Care Services Llc | |
|
17393 S Rock Creek Rd Shawnee OK 74801-9557 | |
| (469) 387-0861 | |
| Not Available |
| Full Name | Meridian Long Term Care Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 17393 S Rock Creek Rd, Shawnee, Oklahoma |
| Authorized Official Name and Position | Angela Motley (OWNER) |
| Authorized Official Contact | 4693870861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meridian Long Term Care Services Llc 17393 S Rock Creek Rd Shawnee OK 74801-9557 Ph: (469) 387-0861 | Meridian Long Term Care Services Llc 17393 S Rock Creek Rd Shawnee OK 74801-9557 Ph: (469) 387-0861 |
| NPI Number | 1164176442 |
|---|---|
| Provider Enumeration Date | 02/07/2022 |
| Last Update Date | 02/07/2022 |
| Medicare PECOS PAC ID | 2668866260 |
|---|---|
| Medicare Enrollment ID | O20220224001659 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164176442 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kelly Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871554139 PECOS PAC ID: 6002824323 Enrollment ID: I20060719000251 |
| Provider Name | Ryan K Aldrich |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760555130 PECOS PAC ID: 3577665306 Enrollment ID: I20070226000643 |
| Provider Name | Addie B Gratz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669498051 PECOS PAC ID: 8224126834 Enrollment ID: I20071115000308 |
| Provider Name | Carol L Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194119016 PECOS PAC ID: 2860792157 Enrollment ID: I20151118000157 |
| Provider Name | Amy J Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699260471 PECOS PAC ID: 1355692823 Enrollment ID: I20180921001459 |
| Provider Name | Stanley Eugene Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780141747 PECOS PAC ID: 6204262249 Enrollment ID: I20200211000525 |
| Provider Name | Angela Motley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093486342 PECOS PAC ID: 3577957174 Enrollment ID: I20220224001995 |
| Provider Name | Stephanie Megan Choate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720570609 PECOS PAC ID: 4183975733 Enrollment ID: I20231020001147 |
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