| Utica Park Clinic Family Medicine | |
|
1301 Ne 1st St Ste 400 Pryor OK 74361 | |
| (918) 824-8000 | |
| (918) 825-5505 |
| Full Name | Utica Park Clinic Family Medicine |
|---|---|
| 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 |
|---|---|
| Utica Park Clinic Family Medicine 1301 Ne 1st St Ste 400 Pryor OK 74361-8851 Ph: (918) 824-8000 | Utica Park Clinic Family Medicine 1301 Ne 1st St Ste 400 Pryor OK 74361 Ph: (918) 824-8000 |
| NPI Number | 1740787928 |
|---|---|
| Provider Enumeration Date | 04/12/2018 |
| Last Update Date | 06/04/2019 |
| Medicare PECOS PAC ID | 3072880624 |
|---|---|
| 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 |
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