| Squareone Medical Center | |
|
5323 South 65th West Avenue Tulsa OK 74107 | |
| (918) 340-5024 | |
| Not Available |
| Full Name | Squareone Medical Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 5323 South 65th West Avenue, Tulsa, Oklahoma |
| Authorized Official Name and Position | Matthew Riley Blair (PRESIDENT) |
| Authorized Official Contact | 9185214185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Squareone Medical Center 5323 South 65th West Avenue Tulsa OK 74107 Ph: (918) 340-5024 | Squareone Medical Center 5323 South 65th West Avenue Tulsa OK 74107 Ph: (918) 340-5024 |
| NPI Number | 1508493784 |
|---|---|
| Provider Enumeration Date | 03/26/2020 |
| Last Update Date | 12/31/2021 |
| Medicare PECOS PAC ID | 6507296845 |
|---|---|
| Medicare Enrollment ID | O20200428001983 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508493784 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Abel L Lau |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174545040 PECOS PAC ID: 8921186024 Enrollment ID: I20141201000581 |
| Provider Name | Rebecca Lynn Wright |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1801183249 PECOS PAC ID: 6709195951 Enrollment ID: I20180424002889 |
| Provider Name | Jennifer F Blair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255890935 PECOS PAC ID: 4284975947 Enrollment ID: I20190405000580 |
| Provider Name | Stacie Marie Cortright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598350779 PECOS PAC ID: 2365851110 Enrollment ID: I20210506001723 |
| Provider Name | Cortney Ranae Rochester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285256883 PECOS PAC ID: 6103218482 Enrollment ID: I20220118001968 |
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