| Nr Bartlesville Llc | |
|
4140 Se Adams Rd Ste 110 Bartlesville OK 74006-8450 | |
| (918) 936-2991 | |
| (405) 669-3517 |
| Full Name | Nr Bartlesville Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 4140 Se Adams Rd Ste 110, Bartlesville, Oklahoma |
| Authorized Official Name and Position | Timothy Coit Bales (CEO/OWNER) |
| Authorized Official Contact | 4057246902 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nr Bartlesville Llc 3705 Nw 63rd St Ste 101 Oklahoma City OK 73116-1937 Ph: (405) 724-6902 | Nr Bartlesville Llc 4140 Se Adams Rd Ste 110 Bartlesville OK 74006-8450 Ph: (918) 936-2991 |
| NPI Number | 1114769189 |
|---|---|
| Provider Enumeration Date | 06/11/2024 |
| Last Update Date | 06/11/2024 |
| Medicare PECOS PAC ID | 9830620665 |
|---|---|
| Medicare Enrollment ID | O20241004000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114769189 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Mark R Woodson |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1225032246 PECOS PAC ID: 6204808801 Enrollment ID: I20040812000522 |
| Provider Name | Elizabeth Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285128090 PECOS PAC ID: 8123403995 Enrollment ID: I20230913003841 |
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