| Prairie Gardens Medical Llc | |
|
1213 Nw 122nd St Ste 401 Oklahoma City OK 73114-7000 | |
| (405) 962-9123 | |
| (405) 962-8125 |
| Full Name | Prairie Gardens Medical Llc |
|---|---|
| Speciality | General Practice |
| Location | 1213 Nw 122nd St Ste 401, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Dianne Genene Tupper (PRACTICE MANAGER) |
| Authorized Official Contact | 4057428898 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prairie Gardens Medical Llc 175 Lary Ln Guthrie OK 73044-6542 Ph: (405) 962-8123 | Prairie Gardens Medical Llc 1213 Nw 122nd St Ste 401 Oklahoma City OK 73114-7000 Ph: (405) 962-9123 |
| NPI Number | 1689280067 |
|---|---|
| Provider Enumeration Date | 09/21/2020 |
| Last Update Date | 09/29/2020 |
| Medicare PECOS PAC ID | 6305265877 |
|---|---|
| Medicare Enrollment ID | O20201001003324 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689280067 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Joel S Tupper |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1427083609 PECOS PAC ID: 1456328558 Enrollment ID: I20040916000495 |
| Provider Name | William K Smith |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1629050364 PECOS PAC ID: 2466524368 Enrollment ID: I20080710000060 |
| Provider Name | Margaret Lorimor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790735371 PECOS PAC ID: 5395776959 Enrollment ID: I20080925000599 |
| Provider Name | Jeffrey Courcier |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1205935251 PECOS PAC ID: 7012062102 Enrollment ID: I20090825000483 |
| Provider Name | Daniel Jones |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1538169883 PECOS PAC ID: 1759413917 Enrollment ID: I20100723000227 |
| Provider Name | Liem Q Trang |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1619084738 PECOS PAC ID: 8426181207 Enrollment ID: I20100730000139 |
| Provider Name | Matthew J Jared |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205060183 PECOS PAC ID: 2264609916 Enrollment ID: I20120119000914 |
| Provider Name | Melinda Courcier |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1831337955 PECOS PAC ID: 3476860297 Enrollment ID: I20160505000158 |
| Provider Name | Susan Alfert |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457831943 PECOS PAC ID: 6901134972 Enrollment ID: I20190829000412 |
| Provider Name | Lan-uyen Trang Stephanie Nguyen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174152680 PECOS PAC ID: 9537514401 Enrollment ID: I20231012001324 |
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