| Dr Bruce Wayne Staeheli, MD | |
|
119 Clubhouse Pl, Elk City, OK 73644-7301 | |
| (580) 303-4664 | |
| Not Available |
| Full Name | Dr Bruce Wayne Staeheli |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 119 Clubhouse Pl, Elk City, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508998899 | NPI | - | NPPES |
| 1062641 | Other | WV | WV DWC |
| 000000561000 | Other | OH | ANTHEM |
| 3810012159 | Medicaid | WV | |
| 000000381808 | Other | OH | ANTHEM |
| 2015698 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | 35 072661 (Ohio) | Primary |
| Entity Name | Dhhs Phs Naihs Crownpoint Hospital |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1114960093 PECOS PAC ID: 0143128041 Enrollment ID: O20031230000393 |
| Entity Name | Concord Medical Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083630610 PECOS PAC ID: 0446296818 Enrollment ID: O20050707000531 |
| Entity Name | Victoria Emergency Partners Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1164770996 PECOS PAC ID: 7012165939 Enrollment ID: O20120919000322 |
| Entity Name | Concord Medical Group Of Texas Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750790762 PECOS PAC ID: 7810117223 Enrollment ID: O20141007002567 |
| Entity Name | Emergency Services Of Texas Pa |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174932131 PECOS PAC ID: 7517289291 Enrollment ID: O20141208002099 |
| Entity Name | Sterling Initiatives |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326452947 PECOS PAC ID: 6709100811 Enrollment ID: O20150121000251 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Bruce Wayne Staeheli, MD Po Box 2467, Elk City, OK 73648-2467 Ph: (580) 303-4664 | Dr Bruce Wayne Staeheli, MD 119 Clubhouse Pl, Elk City, OK 73644-7301 Ph: (580) 303-4664 |
James Lyndon Johnson, MD Emergency Medicine Medicare: Medicare Enrolled Practice Location: 1705 W 2nd, Elk City, OK 73644 Phone: 580-225-2511 Fax: 580-821-5536 | |
Robert Wayne King, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 1705 W 2nd, Elk City, OK 73644 Phone: 580-225-2511 Fax: 580-821-5536 |