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201 W 1st St Grandfield OK 73546-9236 | |
(405) 632-6688 | |
(580) 479-3245 |
Full Name | |
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Speciality | Clinic/Center |
Location | 201 W 1st St, Grandfield, Oklahoma |
Authorized Official Name and Position | Tim Reddout (CFO) |
Authorized Official Contact | 4056326688 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3000 N Grand Blvd Oklahoma City OK 73107-1818 Ph: (405) 632-6688 | 201 W 1st St Grandfield OK 73546-9236 Ph: (405) 632-6688 |
NPI Number | 1336527928 |
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Provider Enumeration Date | 05/14/2015 |
Last Update Date | 02/26/2020 |
Medicare PECOS PAC ID | 1557260007 |
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Medicare Enrollment ID | O20150819008195 |
Identifier | Type | State | Issuer |
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1336527928 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |