| Transformation Health Pllc | |
|
12142 S Yukon Ave Glenpool OK 74033 | |
| (918) 935-3636 | |
| (918) 296-7934 |
| Full Name | Transformation Health Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 12142 S Yukon Ave, Glenpool, Oklahoma |
| Authorized Official Name and Position | Chad Edwards (OWNER) |
| Authorized Official Contact | 9189353636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Health Pllc 12142 S Yukon Ave Glenpool OK 74033 Ph: (918) 935-3636 | Transformation Health Pllc 12142 S Yukon Ave Glenpool OK 74033 Ph: (918) 935-3636 |
| NPI Number | 1497263818 |
|---|---|
| Provider Enumeration Date | 01/19/2018 |
| Last Update Date | 11/08/2022 |
| Medicare PECOS PAC ID | 3476895822 |
|---|---|
| Medicare Enrollment ID | O20190503001849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497263818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Anthony C Echols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992765457 PECOS PAC ID: 6103902226 Enrollment ID: I20080328000482 |
| Provider Name | Benjamin Holler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902335698 PECOS PAC ID: 1658621529 Enrollment ID: I20240422002778 |
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