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105 N Bryant Suite 305 Edmond OK 73034 | |
| (405) 330-8641 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 105 N Bryant, Edmond, 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 |
|---|---|
1122 Ne 13th St Ori236 Oklahoma City OK 73117-1039 Ph: (405) 271-1515 | 105 N Bryant Suite 305 Edmond OK 73034 Ph: (405) 330-8641 |
| NPI Number | 1740383603 |
|---|---|
| Provider Enumeration Date | 09/06/2006 |
| Last Update Date | 10/05/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740383603 | NPI | - | NPPES |
| 1173440010 | Other | OK | DME PALMETTO MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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