Pushmataha Family Medical Center, Inc | |
109 Stanley Road Clayton OK 74536 | |
(918) 569-4143 | |
(918) 569-7343 |
Full Name | Pushmataha Family Medical Center, Inc |
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Speciality | Clinic/Center |
Location | 109 Stanley Road, Clayton, Oklahoma |
Authorized Official Name and Position | Angela Renee Batton (CEO) |
Authorized Official Contact | 9185694143 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pushmataha Family Medical Center, Inc Po Box 219 Clayton OK 74536 Ph: (918) 569-4143 | Pushmataha Family Medical Center, Inc 109 Stanley Road Clayton OK 74536 Ph: (918) 569-4143 |
NPI Number | 1891882676 |
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Provider Enumeration Date | 10/05/2006 |
Last Update Date | 02/02/2011 |
Medicare PECOS PAC ID | 9537189261 |
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Medicare Enrollment ID | O20081114000464 |
Identifier | Type | State | Issuer |
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1891882676 | NPI | - | NPPES |
622460 | Other | OK | UNIVERSAL DATA SYSTEM |
200072150B | Medicaid | OK |
Provider Name | Donald Brooks |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1790754281 PECOS PAC ID: 6800080979 Enrollment ID: I20101102001312 |
Provider Name | Amanda L Vandenburg |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1528430998 PECOS PAC ID: 0648570010 Enrollment ID: I20151208001502 |
Provider Name | Dakota S Waldroop |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1346471711 PECOS PAC ID: 4486709359 Enrollment ID: I20160120001993 |
Provider Name | Laura Maple Turner |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1225297781 PECOS PAC ID: 9335414390 Enrollment ID: I20171002002487 |
Provider Name | Vu A Ngo |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1437565116 PECOS PAC ID: 6507176922 Enrollment ID: I20180108003005 |
Provider Name | Cody Blaine Powell |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1609350057 PECOS PAC ID: 4486991239 Enrollment ID: I20190131002997 |
Provider Name | Jodie H Moore |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669031266 PECOS PAC ID: 3779810882 Enrollment ID: I20190813001246 |
Provider Name | Christopher Lynn Smith |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1669021580 PECOS PAC ID: 6800228677 Enrollment ID: I20200131001583 |
Provider Name | Paula Brown |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1992306708 PECOS PAC ID: 7214349471 Enrollment ID: I20201211000009 |
Provider Name | Heather Janelle Blagg |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1073296604 PECOS PAC ID: 3072960442 Enrollment ID: I20231106003494 |
Provider Name | Kelly Marie Roberts |
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Provider Type | Practitioner - Marriage And Family Therapist |
Provider Identifiers | NPI Number: 1790832632 PECOS PAC ID: 5294965984 Enrollment ID: I20240202002517 |