| |
1943 W 33rd St Ste 100 Edmond OK 73013-3910 | |
(405) 906-3345 | |
(405) 906-3426 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1943 W 33rd St Ste 100, Edmond, Oklahoma |
Authorized Official Name and Position | Melinda Valls Mackey (OWNER) |
Authorized Official Contact | 4059063345 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1943 W 33rd St Ste 100 Edmond OK 73013-3910 Ph: (405) 906-3345 | 1943 W 33rd St Ste 100 Edmond OK 73013-3910 Ph: (405) 906-3345 |
NPI Number | 1841042660 |
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Provider Enumeration Date | 04/04/2024 |
Last Update Date | 04/09/2024 |
Medicare PECOS PAC ID | 8426595620 |
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Medicare Enrollment ID | O20240806002482 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841042660 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Melinda Mackey |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1730353525 PECOS PAC ID: 4688815095 Enrollment ID: I20150409000515 |
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