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1705 Renaissance Blvd Edmond OK 73013-3041 | |
| (405) 844-4978 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1705 Renaissance Blvd, Edmond, Oklahoma |
| Authorized Official Name and Position | Craig Carson (PRESIDENT) |
| Authorized Official Contact | 4058444978 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1701 Renaissance Blvd Edmond OK 73013-3086 Ph: (405) 844-4978 | 1705 Renaissance Blvd Edmond OK 73013-3041 Ph: (405) 844-4978 |
| NPI Number | 1083137939 |
|---|---|
| Provider Enumeration Date | 07/24/2017 |
| Last Update Date | 07/24/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083137939 | NPI | - | NPPES |
| 200267800A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 17555 (Oklahoma) | Primary |
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