| Specialty Clinics Of St Anne Pllc | |
|
350 Ne 12th St Guymon OK 73942-3624 | |
| (580) 338-8700 | |
| (580) 338-8600 |
| Full Name | Specialty Clinics Of St Anne Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 350 Ne 12th St, Guymon, Oklahoma |
| Authorized Official Name and Position | Martin Bautista (MD) |
| Authorized Official Contact | 5803388700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialty Clinics Of St Anne Pllc 350 Ne 12th St Guymon OK 73942-3624 Ph: (580) 338-8700 | Specialty Clinics Of St Anne Pllc 350 Ne 12th St Guymon OK 73942-3624 Ph: (580) 338-8700 |
| NPI Number | 1356360473 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 02/03/2015 |
| Medicare PECOS PAC ID | 8022028273 |
|---|---|
| Medicare Enrollment ID | O20060502000699 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356360473 | NPI | - | NPPES |
| 100748490A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 26523 (Oklahoma) | Secondary |
| 207R00000X | Internal Medicine | 19756 (Oklahoma) | Primary |
| 207R00000X | Internal Medicine | 19772 (Oklahoma) | Secondary |
| Provider Name | Sylvia T Tan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700809720 PECOS PAC ID: 0143286401 Enrollment ID: I20041208000442 |
| Provider Name | Emmanuel L Barias |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316998024 PECOS PAC ID: 9133123730 Enrollment ID: I20081007000630 |
| Provider Name | Martin Bautista |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144249327 PECOS PAC ID: 1759391915 Enrollment ID: I20100902000478 |
| Provider Name | Dennis A Fito |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346477585 PECOS PAC ID: 7315102761 Enrollment ID: I20131108000608 |
Internal Medicine Clinic Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 410 Ne 12th Street, Guymon, OK 73942 Phone: 580-338-5500 Fax: 580-468-4942 | |
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