| Nr Edmond Llc | |
|
3520 S Boulevard Ste 100 Edmond OK 73013-5413 | |
| (405) 495-7391 | |
| (405) 669-3517 |
| Full Name | Nr Edmond Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 3520 S Boulevard Ste 100, Edmond, Oklahoma |
| Authorized Official Name and Position | Timothy 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 |
|---|---|
| Nr Edmond Llc 3908 N Peniel Ave Ste 450 Bethany OK 73008-3402 Ph: (405) 495-7391 | Nr Edmond Llc 3520 S Boulevard Ste 100 Edmond OK 73013-5413 Ph: (405) 495-7391 |
| NPI Number | 1659144384 |
|---|---|
| Provider Enumeration Date | 11/03/2023 |
| Last Update Date | 11/03/2023 |
| Medicare PECOS PAC ID | 5193174498 |
|---|---|
| Medicare Enrollment ID | O20231212002908 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659144384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| Provider Name | Anne A Munson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1275584849 PECOS PAC ID: 3375508468 Enrollment ID: I20041201000001 |
| Provider Name | Sheila Diane Moss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164982104 PECOS PAC ID: 0446682827 Enrollment ID: I20191125000725 |
| Provider Name | Latrica Louise Dorsey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538696083 PECOS PAC ID: 1658777024 Enrollment ID: I20210909003063 |
| Provider Name | Becky Annie Raju |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487423216 PECOS PAC ID: 8729421300 Enrollment ID: I20240212000139 |
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