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1150 E Lansing St Broken Arrow OK 74012-2429 | |
| (918) 895-9565 | |
| (405) 669-3517 |
| Full Name | |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 1150 E Lansing St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Tim Coit Bales (CEO) |
| Authorized Official Contact | 4055016261 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3705 Nw 63rd St Ste 101 Oklahoma City OK 73116-1937 Ph: (918) 895-9565 | 1150 E Lansing St Broken Arrow OK 74012-2429 Ph: (918) 895-9565 |
| NPI Number | 1841053782 |
|---|---|
| Provider Enumeration Date | 02/02/2024 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 3375981723 |
|---|---|
| Medicare Enrollment ID | O20240403003687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841053782 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Alexa G Woodson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720082266 PECOS PAC ID: 6103853460 Enrollment ID: I20050719000855 |
| Provider Name | Janet Seals |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689208191 PECOS PAC ID: 7214350289 Enrollment ID: I20200709000724 |
| Provider Name | Elizabeth Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285128090 PECOS PAC ID: 8123403995 Enrollment ID: I20230913003841 |
| Provider Name | Alexis Nichole Batiste |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467210732 PECOS PAC ID: 9436599842 Enrollment ID: I20240502002054 |
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