| Black Oak Clinic Llc | |
|
110 W 1st St Broken Bow OK 74728 | |
| (580) 584-3099 | |
| (580) 584-3097 |
| Full Name | Black Oak Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 110 W 1st St, Broken Bow, Oklahoma |
| Authorized Official Name and Position | Megan Elizabeth Black (OWNER/NURSE PRACTITIONER) |
| Authorized Official Contact | 5805843099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black Oak Clinic Llc 110 W 1st St Broken Bow OK 74728-3902 Ph: (405) 628-8901 | Black Oak Clinic Llc 110 W 1st St Broken Bow OK 74728 Ph: (580) 584-3099 |
| NPI Number | 1366954661 |
|---|---|
| Provider Enumeration Date | 10/26/2017 |
| Last Update Date | 08/07/2018 |
| Medicare PECOS PAC ID | 7012275027 |
|---|---|
| Medicare Enrollment ID | O20171221000642 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366954661 | NPI | - | NPPES |
| 200740450A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Megan E Black |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568820140 PECOS PAC ID: 9234437559 Enrollment ID: I20160419002270 |
Tlc Family Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 700 W. Jones, Tlc Family Clinic, Llc, Broken Bow, OK 74728 Phone: 580-584-2643 | |
Monty J Grugan Do Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 117 N Broadway St, Broken Bow, OK 74728 Phone: 580-584-3246 | |
Kiamichi Family Medical Center Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6026 Battiest Pickens Rd, Broken Bow, OK 74728 Phone: 580-241-5294 Fax: 580-241-5739 | |
Choctaw Nation Of Oklahoma Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1300 E Martin Luther King Dr, Broken Bow, OK 74728 Phone: 918-567-7000 Fax: 918-567-7180 | |
Mccurtain Family Medical Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 800 N Park Dr, Broken Bow, OK 74728 Phone: 580-584-7210 Fax: 580-584-7213 | |
Hochatown Medical Clinic Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6613 N Us Highway 259, Broken Bow, OK 74728 Phone: 918-689-2500 |