| Windsor Park Medical Clinic, Llc | |
|
2512 N Meridian Ave Oklahoma City OK 73107-1035 | |
| (405) 605-5415 | |
| Not Available |
| Full Name | Windsor Park Medical Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2512 N Meridian Ave, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Kehdinga Nukuna (OWNER) |
| Authorized Official Contact | 4056055415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Windsor Park Medical Clinic, Llc 2512 N Meridian Ave Oklahoma City OK 73107-1035 Ph: (405) 605-5415 | Windsor Park Medical Clinic, Llc 2512 N Meridian Ave Oklahoma City OK 73107-1035 Ph: (405) 605-5415 |
| NPI Number | 1699823617 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 11/07/2019 |
| Medicare PECOS PAC ID | 4385686278 |
|---|---|
| Medicare Enrollment ID | O20050601001022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699823617 | NPI | - | NPPES |
| 200029970B | Medicaid | OK | |
| 37D1027083 | Other | OK | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Alex Dwuma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417275041 PECOS PAC ID: 5698926111 Enrollment ID: I20131217000808 |
| Provider Name | Yombi Melanie Ngouanyo Taponno |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588101596 PECOS PAC ID: 4789960311 Enrollment ID: I20170417000452 |
| Provider Name | Kehdinga Nukuna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073172607 PECOS PAC ID: 2668603986 Enrollment ID: I20191120003019 |
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