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1084 Nickerson St Waynoka OK 73860-1245 | |
| (580) 824-2291 | |
| (580) 824-0429 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1084 Nickerson St, Waynoka, Oklahoma |
| Authorized Official Name and Position | Greg A Meyers (VP INTEGRIS REGIONAL PHYS PRACT MGM) |
| Authorized Official Contact | 5809771831 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 5038 Enid OK 73702-5038 Ph: (580) 548-1367 | 1084 Nickerson St Waynoka OK 73860-1245 Ph: (580) 824-2291 |
| NPI Number | 1124029293 |
|---|---|
| Provider Enumeration Date | 08/10/2005 |
| Last Update Date | 12/16/2013 |
| Medicare PECOS PAC ID | 0345151981 |
|---|---|
| Medicare Enrollment ID | O20031103000717 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124029293 | NPI | - | NPPES |
| 100699500K | Medicaid | OK | |
| 100755790C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Steven R Mareburger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215999479 PECOS PAC ID: 6507760733 Enrollment ID: I20031120000474 |
| Provider Name | Jeffrey R Jones |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295735355 PECOS PAC ID: 6800884602 Enrollment ID: I20040501000462 |
| Provider Name | Linda S Woodruff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568424190 PECOS PAC ID: 4183603103 Enrollment ID: I20040714001106 |
| Provider Name | Kayla D Lakin Southern |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205815537 PECOS PAC ID: 6709840168 Enrollment ID: I20041116000085 |
| Provider Name | Syed M Rizvi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1528175619 PECOS PAC ID: 2769437276 Enrollment ID: I20050504000904 |
| Provider Name | Clinton G Wallis |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1255384483 PECOS PAC ID: 6901819168 Enrollment ID: I20060718000281 |
| Provider Name | Brian D Whitson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1053355073 PECOS PAC ID: 8426052531 Enrollment ID: I20060901000351 |
| Provider Name | Brian W Cook |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275638835 PECOS PAC ID: 7416052329 Enrollment ID: I20070423000238 |
| Provider Name | Kenneth Andrew Seres |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1871633404 PECOS PAC ID: 0840365292 Enrollment ID: I20080819000628 |
| Provider Name | Jami L Benton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639224264 PECOS PAC ID: 7416024542 Enrollment ID: I20080916000162 |
| Provider Name | Dustin L Baylor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376746925 PECOS PAC ID: 5597826214 Enrollment ID: I20081212000285 |
| Provider Name | Jennifer K Norman |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1437325438 PECOS PAC ID: 3779649876 Enrollment ID: I20090225000305 |
| Provider Name | Charles H Morgan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1336231430 PECOS PAC ID: 6901719178 Enrollment ID: I20090323000371 |
| Provider Name | Jeff Scott |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649245929 PECOS PAC ID: 7517031297 Enrollment ID: I20100428000769 |
| Provider Name | David S Stokesberry |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1427032234 PECOS PAC ID: 9931204385 Enrollment ID: I20100810000293 |
| Provider Name | Carl A Raczkowski |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1851375646 PECOS PAC ID: 5193782977 Enrollment ID: I20100810000727 |
| Provider Name | Elizabeth R Kinzie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1760450472 PECOS PAC ID: 2365636354 Enrollment ID: I20101103001173 |
| Provider Name | Jon R Mills |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952627069 PECOS PAC ID: 0648446203 Enrollment ID: I20120103000174 |
| Provider Name | David A. Neumann |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1043339575 PECOS PAC ID: 5294821096 Enrollment ID: I20120703000624 |
| Provider Name | Laelani M Baca |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831506849 PECOS PAC ID: 7810116225 Enrollment ID: I20140917002083 |
| Provider Name | Sumit A Walia |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1295963247 PECOS PAC ID: 2567782642 Enrollment ID: I20150514000422 |
| Provider Name | Salman Nusrat |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1578799508 PECOS PAC ID: 8921310731 Enrollment ID: I20150708001557 |
| Provider Name | Neil E Crittenden |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1598907115 PECOS PAC ID: 2668628454 Enrollment ID: I20160727000831 |
| Provider Name | Michael D Landes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174516967 PECOS PAC ID: 1153304175 Enrollment ID: I20171228001784 |
| Provider Name | Laura J Hofferber |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225548647 PECOS PAC ID: 6002175957 Enrollment ID: I20180122002468 |
| Provider Name | Adrienne Tess Hernandez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932694957 PECOS PAC ID: 5597015164 Enrollment ID: I20180830003115 |
| Provider Name | Marie Marianne Mccune |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639712326 PECOS PAC ID: 8426486937 Enrollment ID: I20200317000431 |
| Provider Name | Christina J Erford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992310882 PECOS PAC ID: 5698195741 Enrollment ID: I20201012001915 |
| Provider Name | Arifa Mamoona Khan |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1144571662 PECOS PAC ID: 8224335724 Enrollment ID: I20210121001610 |
| Provider Name | Courtney Nicole Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326637471 PECOS PAC ID: 8921414277 Enrollment ID: I20210310002869 |
| Provider Name | Molly Kay Partee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376063321 PECOS PAC ID: 6800166919 Enrollment ID: I20210621002757 |
| Provider Name | Zachary Daniel Smith |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1437537024 PECOS PAC ID: 8022368950 Enrollment ID: I20210709000111 |
| Provider Name | Nathan Veral Hollenbeck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083283329 PECOS PAC ID: 4183091184 Enrollment ID: I20221103003043 |
| Provider Name | George Hudson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386267425 PECOS PAC ID: 2961826425 Enrollment ID: I20230821002258 |
| Provider Name | Rohtashav Dhir |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1881808715 PECOS PAC ID: 4880785997 Enrollment ID: I20240804000040 |
Alva Hospital Authority/dba Share Medical Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1630 Santa Fe St, Waynoka, OK 73860 Phone: 580-327-2800 | |
The Medical Clinic, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1630 Santa Fe St., Waynoka, OK 73860 Phone: 580-824-0330 Fax: 580-824-0939 |