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201 North 32nd Street Muskogee OK 74401-2104 | |
(918) 912-2333 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 201 North 32nd Street, Muskogee, Oklahoma |
Authorized Official Name and Position | Marcus Deon Johnson (QI) |
Authorized Official Contact | 9184830111 |
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 334 Porter OK 74454-0334 Ph: (918) 483-0111 | 201 North 32nd Street Muskogee OK 74401-2104 Ph: (918) 912-2333 |
NPI Number | 1568976991 |
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Provider Enumeration Date | 11/21/2017 |
Last Update Date | 12/20/2017 |
Medicare PECOS PAC ID | 2961594916 |
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Medicare Enrollment ID | O20180126000896 |
Identifier | Type | State | Issuer |
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1568976991 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (Oklahoma) | Primary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oklahoma) | Secondary |
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