| Shockey Internal Medicine Pc | |
|
2419 Chickasaw Blvd Ardmore OK 73401-1466 | |
| (580) 223-6767 | |
| (580) 224-0275 |
| Full Name | Shockey Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2419 Chickasaw Blvd, Ardmore, Oklahoma |
| Authorized Official Name and Position | Brian Michael Shockey (OWNER) |
| Authorized Official Contact | 5802236767 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shockey Internal Medicine Pc 2419 Chickasaw Blvd Ardmore OK 73401-1466 Ph: (580) 223-6767 | Shockey Internal Medicine Pc 2419 Chickasaw Blvd Ardmore OK 73401-1466 Ph: (580) 223-6767 |
| NPI Number | 1437211406 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 05/15/2008 |
| Medicare PECOS PAC ID | 7810978178 |
|---|---|
| Medicare Enrollment ID | O20040525000397 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437211406 | NPI | - | NPPES |
| 100202500A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 18264 (Oklahoma) | Primary |
| Provider Name | Brian M Shockey |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366404105 PECOS PAC ID: 2264413533 Enrollment ID: I20040525000526 |
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