| Utica Park Clinic Elliott | |
|
562 S Elliott St Pryor OK 74361 | |
| (918) 824-8000 | |
| (918) 825-5505 |
| Full Name | Utica Park Clinic Elliott |
|---|---|
| Speciality | Clinic/Center |
| Location | 562 S Elliott St, Pryor, Oklahoma |
| Authorized Official Name and Position | Stephen C. Petrovich (EVP) |
| Authorized Official Contact | 6152963000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Utica Park Clinic Elliott 1 Burton Hills Blvd Ste 250 Nashville TN 37215-6195 Ph: (615) 296-3000 | Utica Park Clinic Elliott 562 S Elliott St Pryor OK 74361 Ph: (918) 824-8000 |
| NPI Number | 1134632037 |
|---|---|
| Provider Enumeration Date | 11/14/2017 |
| Last Update Date | 12/31/2018 |
| Medicare PECOS PAC ID | 3072880624 |
|---|---|
| Medicare Enrollment ID | O20171121001335 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134632037 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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