Full Name | |
---|---|
Speciality | Clinic/center - Primary Care |
Location | 104 W Broadway, Vici, Oklahoma |
Authorized Official Name and Position | Jennifer Coons (ADMINISTRATOR) |
Authorized Official Contact | 5809227361 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 720 Seiling OK 73663-0720 Ph: (580) 922-7361 | 104 W Broadway Vici OK 73859-5900 Ph: (580) 995-3004 |
NPI Number | 1861800039 |
---|---|
Provider Enumeration Date | 07/31/2014 |
Last Update Date | 08/02/2016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1861800039 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (Oklahoma) | Primary |
Leslie Clinic Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Rr 1 Box A1, Vici, OK 73859 Phone: 580-995-3200 Fax: 580-995-3202 | |