| Wyko Llc | |
|
310 Longleaf Cir Monroeville AL 36460-1563 | |
| (256) 682-9637 | |
| Not Available |
| Full Name | Wyko Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 310 Longleaf Cir, Monroeville, Alabama |
| Authorized Official Name and Position | Thomas Broughton (OWNER) |
| Authorized Official Contact | 2566829637 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wyko Llc 310 Longleaf Cir Monroeville AL 36460-1563 Ph: () - | Wyko Llc 310 Longleaf Cir Monroeville AL 36460-1563 Ph: (256) 682-9637 |
| NPI Number | 1366211377 |
|---|---|
| Provider Enumeration Date | 01/02/2024 |
| Last Update Date | 07/10/2024 |
| Medicare PECOS PAC ID | 2860837358 |
|---|---|
| Medicare Enrollment ID | O20240223001898 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366211377 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Thomas W Broughton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073778023 PECOS PAC ID: 0941472872 Enrollment ID: I20111018000711 |
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