| Jim Wallace & Associates Inc | |
|
1610 W Jackson St Hugo OK 74743-5653 | |
| (405) 665-4385 | |
| (405) 665-6396 |
| Full Name | Jim Wallace & Associates Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1610 W Jackson St, Hugo, Oklahoma |
| Authorized Official Name and Position | Teresa G Rue-wallace (CEO) |
| Authorized Official Contact | 4056654385 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jim Wallace & Associates Inc 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 | Jim Wallace & Associates Inc 1610 W Jackson St Hugo OK 74743-5653 Ph: (405) 665-4385 |
| NPI Number | 1164557492 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 05/31/2025 |
| Certification Date | 05/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164557492 | NPI | - | NPPES |
| 100749080B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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