| Edwin R Henson Iii, MD | |
|
4301 Wilson St, Fort Sill, OK 73503-4472 | |
| (580) 558-2000 | |
| (580) 558-3408 |
| Full Name | Edwin R Henson Iii |
|---|---|
| Gender | Male |
| Speciality | Pediatrics |
| Location | 4301 Wilson St, Fort Sill, Oklahoma |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649265935 | NPI | - | NPPES |
| 100030210C | Other | OK | SOONERCARE |
| 100030210D | Medicaid | OK | |
| 5312321 | Other | OK | AETNA |
| 370015724 | Other | OK | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 16952 (Oklahoma) | Primary |
| Entity Name | Southwestern Surgical Affiliates, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1013169531 PECOS PAC ID: 0941365308 Enrollment ID: O20090218000457 |
| Mailing Address | Practice Location Address |
|---|---|
| Edwin R Henson Iii, MD 4301 Wilson St, Fort Sill, OK 73503-4472 Ph: (580) 558-2000 | Edwin R Henson Iii, MD 4301 Wilson St, Fort Sill, OK 73503-4472 Ph: (580) 558-2000 |
Dr. Timothy Neil Laughy, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4301 Wilson St, Qsd-credentials, Fort Sill, OK 73503 Phone: 580-558-2000 Fax: 580-558-3408 | |
Timothy Flynn, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 4301 Wilson St, Pediatrics, Fort Sill, OK 73503 Phone: 580-558-2800 |