Nerve Renewal Broken Arrow | |
1150 E Lansing St Broken Arrow OK 74012-2429 | |
(918) 895-9565 | |
(405) 669-3517 |
Full Name | Nerve Renewal Broken Arrow |
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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 |
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Nerve Renewal Broken Arrow 3705 Nw 63rd St Ste 101 Oklahoma City OK 73116-1937 Ph: (918) 895-9565 | Nerve Renewal Broken Arrow 1150 E Lansing St Broken Arrow OK 74012-2429 Ph: (918) 895-9565 |
NPI Number | 1841053782 |
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Provider Enumeration Date | 02/02/2024 |
Last Update Date | 07/10/2024 |
Medicare PECOS PAC ID | 3375981723 |
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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 |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1720082266 PECOS PAC ID: 6103853460 Enrollment ID: I20050719000855 |
Provider Name | Alexis Nichole Batiste |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1467210732 PECOS PAC ID: 9436599842 Enrollment ID: I20240502002054 |
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