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1501 E 19th St Edmond OK 73013-6618 | |
| (405) 471-6511 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 1501 E 19th St, Edmond, Oklahoma |
| Authorized Official Name and Position | Muhammad Sanaullah (CEO) |
| Authorized Official Contact | 4053595370 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
105 S Bryant Ave Ste 108 Edmond OK 73034-6330 Ph: (405) 359-5370 | 1501 E 19th St Edmond OK 73013-6618 Ph: (405) 471-6511 |
| NPI Number | 1760030399 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 11/15/2024 |
| Medicare PECOS PAC ID | 2264853928 |
|---|---|
| Medicare Enrollment ID | O20200604001174 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760030399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 332900000X | Non-pharmacy Dispensing Site | (* (Not Available)) | Secondary |
| Provider Name | Muhammad Sanaullah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699079400 PECOS PAC ID: 0345412656 Enrollment ID: I20111011000155 |
| Provider Name | Susan Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801134390 PECOS PAC ID: 5395980577 Enrollment ID: I20130315000328 |
| Provider Name | Matthew Kenneth Loeber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295135341 PECOS PAC ID: 6800018730 Enrollment ID: I20141110001602 |
| Provider Name | Nicole D Cornish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003296492 PECOS PAC ID: 2163737743 Enrollment ID: I20150811004527 |
| Provider Name | Ayesha Mughal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811243009 PECOS PAC ID: 2365663325 Enrollment ID: I20170123002465 |
| Provider Name | Ayesha Chaudry |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962755744 PECOS PAC ID: 2860794492 Enrollment ID: I20200604001636 |
| Provider Name | Ebelechukwu Ekwenugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710535398 PECOS PAC ID: 3375979289 Enrollment ID: I20201103001128 |
| Provider Name | Binita Ghimire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992380158 PECOS PAC ID: 7810383247 Enrollment ID: I20220411001983 |
| Provider Name | Gabrielle Michelle Jimenez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477265866 PECOS PAC ID: 6608226501 Enrollment ID: I20231219000100 |
| Provider Name | Venessa Emma Payne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437781283 PECOS PAC ID: 2961829932 Enrollment ID: I20240430000567 |
Deer Creek Family Healthcare And Wellness Clinic Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 19401 N. Portland, Edmond, OK 73012 Phone: 405-812-8208 | |
Mark R Lynn Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 105 S Bryant Ave, Suite 204a, Edmond, OK 73034 Phone: 405-359-3637 Fax: 405-359-2022 | |
Endo Balance Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2940 Hunter Crest Dr, Edmond, OK 73034 Phone: 917-558-4195 | |
American Current Care P.a. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3406 S Boulevard, Edmond, OK 73013 Phone: 405-230-9700 Fax: 405-230-9711 | |
Canyon Park Medical Group, Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1501 E 19th St, Edmond, OK 73013 Phone: 405-348-6611 Fax: 405-348-9280 |