| Oakwood Springs Physician Group Llc | |
|
13101 Memorial Springs Ct Oklahoma City OK 73114-2226 | |
| (405) 438-3000 | |
| (405) 751-6496 |
| Full Name | Oakwood Springs Physician Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 13101 Memorial Springs Ct, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Paul Fridenstine (CFO) |
| Authorized Official Contact | 4054383000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Oakwood Springs Physician Group Llc 13101 Memorial Springs Ct Oklahoma City OK 73114-2226 Ph: () - | Oakwood Springs Physician Group Llc 13101 Memorial Springs Ct Oklahoma City OK 73114-2226 Ph: (405) 438-3000 |
| NPI Number | 1326588807 |
|---|---|
| Provider Enumeration Date | 03/02/2017 |
| Last Update Date | 03/02/2017 |
| Medicare PECOS PAC ID | 1658658026 |
|---|---|
| Medicare Enrollment ID | O20170512000661 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326588807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Willis Holloway |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023054434 PECOS PAC ID: 9830085869 Enrollment ID: I20040225001083 |
| Provider Name | Darius Noori |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053352872 PECOS PAC ID: 3779562194 Enrollment ID: I20040719000322 |
| Provider Name | Rachael A Tromley |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1790765733 PECOS PAC ID: 9032144589 Enrollment ID: I20051209000772 |
| Provider Name | Benjamin Quiambao |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1770796336 PECOS PAC ID: 6709912413 Enrollment ID: I20100406000414 |
| Provider Name | Fadalia D Kim |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285860643 PECOS PAC ID: 8628265048 Enrollment ID: I20101211000101 |
| Provider Name | Ahsan Y Khan |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1346245479 PECOS PAC ID: 4082640354 Enrollment ID: I20111102000303 |
| Provider Name | Luci Ann Gratch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104102961 PECOS PAC ID: 0547424145 Enrollment ID: I20120612000107 |
| Provider Name | Brett I Cunningham |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730315193 PECOS PAC ID: 8820245558 Enrollment ID: I20120830000670 |
| Provider Name | Susan Jacob |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801134390 PECOS PAC ID: 5395980577 Enrollment ID: I20130315000328 |
| Provider Name | Geetika M Verma |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487967717 PECOS PAC ID: 4284876525 Enrollment ID: I20130815000403 |
| Provider Name | Limei Yang |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003049123 PECOS PAC ID: 2466696778 Enrollment ID: I20130926000096 |
| Provider Name | Preethy T Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881023158 PECOS PAC ID: 1557594389 Enrollment ID: I20140502000094 |
| Provider Name | Tu Bui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659712545 PECOS PAC ID: 8820307804 Enrollment ID: I20151013001707 |
| Provider Name | Thuy H Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1457791444 PECOS PAC ID: 6709186497 Enrollment ID: I20151202001632 |
| Provider Name | Shyvonne N Gray |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639490618 PECOS PAC ID: 6305066044 Enrollment ID: I20160404000036 |
| Provider Name | Dyanna E Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457717928 PECOS PAC ID: 5395034656 Enrollment ID: I20160510001992 |
| Provider Name | William Oliva |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356781199 PECOS PAC ID: 5991025850 Enrollment ID: I20161028000688 |
| Provider Name | Sharon Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598213514 PECOS PAC ID: 1557646171 Enrollment ID: I20170322002463 |
| Provider Name | Amar Kirti Dadwal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649615105 PECOS PAC ID: 0840599619 Enrollment ID: I20170710000642 |
| Provider Name | Enieni E Okoya |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1477751196 PECOS PAC ID: 7911279443 Enrollment ID: I20170818000347 |
| Provider Name | Satera N Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902248123 PECOS PAC ID: 3072886324 Enrollment ID: I20170907002360 |
| Provider Name | Kenneth Richmond |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184891277 PECOS PAC ID: 6608015342 Enrollment ID: I20190806003198 |
| Provider Name | Souzana Alkhouri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184088163 PECOS PAC ID: 5698091460 Enrollment ID: I20201005002961 |
| Provider Name | Ebelechukwu Ekwenugo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710535398 PECOS PAC ID: 3375979289 Enrollment ID: I20201103001128 |
| Provider Name | Eric L Reynolds |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730701624 PECOS PAC ID: 5698172963 Enrollment ID: I20210929002033 |
| Provider Name | Nicole Lynnette Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518531227 PECOS PAC ID: 8921499286 Enrollment ID: I20211221000058 |
| Provider Name | Jessica Caitlin Legrange |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801466644 PECOS PAC ID: 3971988874 Enrollment ID: I20221117002034 |
| Provider Name | Catherine Anyaegbunam |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982378519 PECOS PAC ID: 0042699571 Enrollment ID: I20230824003240 |
| Provider Name | Joycy Puthenpurackal Pranabdev |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194429829 PECOS PAC ID: 0446607873 Enrollment ID: I20231107002403 |
| Provider Name | Marisha Dawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881372159 PECOS PAC ID: 1052762341 Enrollment ID: I20240111000985 |
| Provider Name | Juliet Ashley Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821597832 PECOS PAC ID: 7315031200 Enrollment ID: I20240125000154 |
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