| Nr Southwest Okc Llc | |
|
9821 S May Ave Ste B Oklahoma City OK 73159-7042 | |
| (405) 495-7391 | |
| Not Available |
| Full Name | Nr Southwest Okc Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 9821 S May Ave Ste B, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Tim Bales (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4054957391 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nr Southwest Okc Llc 3908 N Peniel Ave Ste 450 Bethany OK 73008-3402 Ph: (405) 495-7391 | Nr Southwest Okc Llc 9821 S May Ave Ste B Oklahoma City OK 73159-7042 Ph: (405) 495-7391 |
| NPI Number | 1598480220 |
|---|---|
| Provider Enumeration Date | 10/05/2022 |
| Last Update Date | 10/05/2022 |
| Medicare PECOS PAC ID | 4981079373 |
|---|---|
| Medicare Enrollment ID | O20230418000707 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598480220 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Secondary |
| Provider Name | Taylor Lancaster |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1760521645 PECOS PAC ID: 3274686373 Enrollment ID: I20120924000520 |
| Provider Name | Jennifer L Webb |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316378433 PECOS PAC ID: 5294967071 Enrollment ID: I20140409001495 |
| Provider Name | Kristal Ladawn Vasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063030088 PECOS PAC ID: 2769801604 Enrollment ID: I20200928000374 |
| Provider Name | Robin Lynn Shaver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457983579 PECOS PAC ID: 0547697591 Enrollment ID: I20210119002537 |
| Provider Name | Tanya R. Cates |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629699244 PECOS PAC ID: 1658776430 Enrollment ID: I20210817001091 |
| Provider Name | Shayne Preyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962048520 PECOS PAC ID: 2860828951 Enrollment ID: I20240111002265 |
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