| |
1301 Ne 1st St Ste 400 Pryor OK 74361 | |
(918) 824-8000 | |
(918) 825-5505 |
Full Name | |
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Speciality | Clinic/Center |
Location | 1301 Ne 1st St Ste 400, 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 |
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1301 Ne 1st St Ste 400 Pryor OK 74361-8851 Ph: (918) 824-8000 | 1301 Ne 1st St Ste 400 Pryor OK 74361 Ph: (918) 824-8000 |
NPI Number | 1740787928 |
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Provider Enumeration Date | 04/12/2018 |
Last Update Date | 06/04/2019 |
Medicare PECOS PAC ID | 3072880624 |
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Medicare Enrollment ID | O20181130001163 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740787928 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Mayes County Hmpn, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1301 Ne 1st St, Pryor, OK 74361 Phone: 918-824-7714 | |
S Bar D, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 109 N Fairland St Ste 109, Pryor, OK 74361 Phone: 918-825-3107 Fax: 918-825-3128 | |
Prophylaxis Healthcare Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 211 S Mill St, Pryor, OK 74361 Phone: 918-825-3777 Fax: 918-825-3776 | |