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6520 E Reno Ave Ste D Midwest City OK 73110-2119 | |
(405) 455-3008 | |
(405) 393-6329 |
Full Name | |
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Speciality | Clinic/center |
Location | 6520 E Reno Ave Ste D, Midwest City, Oklahoma |
Authorized Official Name and Position | Anataya Rucker (CEO) |
Authorized Official Contact | 4053144451 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 52 Spencer OK 73084-0052 Ph: (405) 455-3008 | 6520 E Reno Ave Ste D Midwest City OK 73110-2119 Ph: (405) 455-3008 |
NPI Number | 1902613490 |
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Provider Enumeration Date | 12/17/2024 |
Last Update Date | 12/18/2024 |
Identifier | Type | State | Issuer |
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1902613490 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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