| Ou Emerson Teen Clinic | |
|
720 N Dewey Ave Oklahoma City OK 73102-1214 | |
| (405) 236-8172 | |
| Not Available |
| Full Name | Ou Emerson Teen Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 720 N Dewey Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Brian Maddy (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 4052711515 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ou Emerson Teen Clinic 1122 Ne 13th St Ori 236 Oklahoma City OK 73117-1039 Ph: () - | Ou Emerson Teen Clinic 720 N Dewey Ave Oklahoma City OK 73102-1214 Ph: (405) 236-8172 |
| NPI Number | 1215154794 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 09/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215154794 | NPI | - | NPPES |
| 100744720N | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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