| Nr Shawnee, Llc | |
|
3700 N Kickapoo Ave Ste 116 Shawnee OK 74804-0007 | |
| (405) 551-8103 | |
| (405) 669-3517 |
| Full Name | Nr Shawnee, Llc |
|---|---|
| Speciality | Physical Medicine & Rehabilitation |
| Location | 3700 N Kickapoo Ave Ste 116, Shawnee, 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 |
|---|---|
| Nr Shawnee, Llc 3705 Nw 63rd St Ste 200 Oklahoma City OK 73116-1937 Ph: (405) 551-8103 | Nr Shawnee, Llc 3700 N Kickapoo Ave Ste 116 Shawnee OK 74804-0007 Ph: (405) 551-8103 |
| NPI Number | 1922861004 |
|---|---|
| Provider Enumeration Date | 02/01/2024 |
| Last Update Date | 02/01/2024 |
| Medicare PECOS PAC ID | 8224476171 |
|---|---|
| Medicare Enrollment ID | O20240410004024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922861004 | 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 | Lauren Michele Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013109297 PECOS PAC ID: 6204015571 Enrollment ID: I20110119001090 |
| Provider Name | Thingal G Masar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417600099 PECOS PAC ID: 3274980107 Enrollment ID: I20231114001379 |
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Ssm Health Medical Group Shawnee Kickapoo Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3700 N Kickapoo Ave, Shawnee, OK 74804 Phone: 405-273-6383 Fax: 405-273-3748 | |
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