| 401 Medical Center Pllc | |
|
401 E Downing St Tahlequah OK 74464-3015 | |
| (918) 316-3764 | |
| (918) 398-8982 |
| Full Name | 401 Medical Center Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 401 E Downing St, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Nancy E. Denton (OWNER/ APRN) |
| Authorized Official Contact | 9183166369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 401 Medical Center Pllc 401 E Downing St Tahlequah OK 74464-3015 Ph: (918) 316-3764 | 401 Medical Center Pllc 401 E Downing St Tahlequah OK 74464-3015 Ph: (918) 316-3764 |
| NPI Number | 1063296937 |
|---|---|
| Provider Enumeration Date | 08/22/2023 |
| Last Update Date | 08/24/2023 |
| Medicare PECOS PAC ID | 7113381377 |
|---|---|
| Medicare Enrollment ID | O20230907000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063296937 | NPI | - | NPPES |
| 1013603232 | Other | OK | NPI |
| 201173250A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Nancy Ellen Denton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013603232 PECOS PAC ID: 7911361175 Enrollment ID: I20230907000707 |
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