| Team Clinics Ah Llc | |
|
3112 Cooke Way Oklahoma City OK 73179-2401 | |
| (405) 546-4130 | |
| Not Available |
| Full Name | Team Clinics Ah Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3112 Cooke Way, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Trevor Nutt (CEO) |
| Authorized Official Contact | 4055464130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: () - | Team Clinics Ah Llc 3112 Cooke Way Oklahoma City OK 73179-2401 Ph: (405) 546-4130 |
| NPI Number | 1366022998 |
|---|---|
| Provider Enumeration Date | 04/08/2021 |
| Last Update Date | 04/08/2021 |
| Medicare PECOS PAC ID | 2860880887 |
|---|---|
| Medicare Enrollment ID | O20211025001911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366022998 | NPI | - | NPPES |
| 200782030 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kevin M Penwell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1841286333 PECOS PAC ID: 8325005580 Enrollment ID: I20041220000487 |
| Provider Name | Richard D Brock |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437131695 PECOS PAC ID: 1658459359 Enrollment ID: I20080422000218 |
| Provider Name | Amy N Hobson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275866980 PECOS PAC ID: 7810036134 Enrollment ID: I20091130000306 |
| Provider Name | Allison L Duncan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235457938 PECOS PAC ID: 2668657057 Enrollment ID: I20110504000510 |
| Provider Name | Carol L Kennedy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194119016 PECOS PAC ID: 2860792157 Enrollment ID: I20151118000157 |
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