| Brayderik Consulting | |
|
1607 S Muskogee Ave Ste C Tahlequah OK 74464-5440 | |
| (918) 931-7232 | |
| Not Available |
| Full Name | Brayderik Consulting |
|---|---|
| Speciality | Podiatrist |
| Location | 1607 S Muskogee Ave Ste C, Tahlequah, Oklahoma |
| Authorized Official Name and Position | Paula J Young (CEO) |
| Authorized Official Contact | 9189317232 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brayderik Consulting 807 W Downing St Tahlequah OK 74464-2719 Ph: (918) 931-7232 | Brayderik Consulting 1607 S Muskogee Ave Ste C Tahlequah OK 74464-5440 Ph: (918) 931-7232 |
| NPI Number | 1235677121 |
|---|---|
| Provider Enumeration Date | 02/10/2017 |
| Last Update Date | 06/24/2021 |
| Medicare PECOS PAC ID | 8224302948 |
|---|---|
| Medicare Enrollment ID | O20170919003598 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235677121 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 213EP1101X | Podiatrist - Primary Podiatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Michael Wayne Hammond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104861616 PECOS PAC ID: 7214952522 Enrollment ID: I20051005001249 |
| Provider Name | Brian E Cookson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356532022 PECOS PAC ID: 6507887692 Enrollment ID: I20080915000634 |
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