| Western Oklahoma Wellness Llc | |
|
1710 W 3rd St Ste 101 Elk City OK 73644-5160 | |
| (580) 225-8600 | |
| (855) 583-1074 |
| Full Name | Western Oklahoma Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1710 W 3rd St Ste 101, Elk City, Oklahoma |
| Authorized Official Name and Position | Charity Bradshaw (MANAGING MEMBER) |
| Authorized Official Contact | 5056104001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Western Oklahoma Wellness Llc 1406 Walters Way Elk City OK 73644-2422 Ph: (505) 610-4001 | Western Oklahoma Wellness Llc 1710 W 3rd St Ste 101 Elk City OK 73644-5160 Ph: (580) 225-8600 |
| NPI Number | 1629842000 |
|---|---|
| Provider Enumeration Date | 11/07/2023 |
| Last Update Date | 11/07/2023 |
| Medicare PECOS PAC ID | 1456796259 |
|---|---|
| Medicare Enrollment ID | O20240304000656 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629842000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Charity Bradshaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538940432 PECOS PAC ID: 2365887163 Enrollment ID: I20240304001109 |
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