| Jim Wallace And Associates Incorporated | |
|
202 S Washita Ave Wynnewood OK 73098-7820 | |
| (405) 665-4385 | |
| (405) 665-6396 |
| Full Name | Jim Wallace And Associates Incorporated |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 202 S Washita Ave, Wynnewood, Oklahoma |
| Authorized Official Name and Position | Teresa Gale Rue-wallace (OWNER/ CEO/PRESIDENT/EXEC. DIRECTOR) |
| Authorized Official Contact | 4053068511 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jim Wallace And Associates Incorporated 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 | Jim Wallace And Associates Incorporated 202 S Washita Ave Wynnewood OK 73098-7820 Ph: (405) 665-4385 |
| NPI Number | 1982748067 |
|---|---|
| Provider Enumeration Date | 02/20/2007 |
| Last Update Date | 09/08/2021 |
| Certification Date | 09/08/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982748067 | NPI | - | NPPES |
| 100749080A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Oklahoma) | Primary |