| Tracey Way Childers, DO | |
|
1203 E Ross Byp, Suite A, Tahlequah, OK 74464-4188 | |
| (918) 453-1234 | |
| (918) 453-9107 |
| Full Name | Tracey Way Childers |
|---|---|
| Gender | Female |
| Speciality | Otolaryngology |
| Experience | 32 Years |
| Location | 1203 E Ross Byp, Tahlequah, Oklahoma |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053371021 | NPI | - | NPPES |
| DA5295 | Other | OK | RAILROAD MEDICARE GROUP NUMBER |
| P00027981 | Other | OK | RAILROAD MEDICARE PIN NUMBER |
| 200000030A | Medicaid | OK | |
| 100257460A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207YX0905X | Otolaryngology - Otolaryngology/facial Plastic Surgery | 3296 (Oklahoma) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Saint Francis Hospital, Inc | Tulsa, OK | Hospital |
| Saint Francis Hospital South, Llc | Tulsa, OK | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Warren Clinic Inc | 8820900293 | 693 |
| Entity Name | Warren Clinic Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1174582282 PECOS PAC ID: 8820900293 Enrollment ID: O20031104000252 |
| Mailing Address | Practice Location Address |
|---|---|
| Tracey Way Childers, DO 1203 E Ross Byp, Suite A, Tahlequah, OK 74464-4188 Ph: (918) 453-1234 | Tracey Way Childers, DO 1203 E Ross Byp, Suite A, Tahlequah, OK 74464-4188 Ph: (918) 453-1234 |
Susan K Anderson, DO Otolaryngology Medicare: Medicare Enrolled Practice Location: 1203 E Ross Byp, Suite A, Tahlequah, OK 74464 Phone: 918-453-1234 Fax: 918-453-9107 | |
Lea Sarah Humphrey, D.O. Otolaryngology Medicare: Accepting Medicare Assignments Practice Location: 1203 E Ross Byp, Tahlequah, OK 74464 Phone: 918-453-1234 Fax: 918-453-9107 | |
Charles Joseph Wine, M.D. Otolaryngology Medicare: Not Enrolled in Medicare Practice Location: 100 S Bliss Ave, Tahlequah, OK 74464 Phone: 918-458-3360 Fax: 918-458-3511 |