| Breedlove Wound Care Of Oklahoma Llc | |
|
207 E Taliaferro St Madill OK 73446-3410 | |
| (903) 947-2020 | |
| Not Available |
| Full Name | Breedlove Wound Care Of Oklahoma Llc |
|---|---|
| Speciality | Surgery |
| Location | 207 E Taliaferro St, Madill, Oklahoma |
| Authorized Official Name and Position | Robert Wilson (ASSISTANT MANAGER CREDENTIALING) |
| Authorized Official Contact | 9563312458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Breedlove Wound Care Of Oklahoma Llc Po Box 1129 Tatum TX 75691-1129 Ph: () - | Breedlove Wound Care Of Oklahoma Llc 207 E Taliaferro St Madill OK 73446-3410 Ph: (903) 947-2020 |
| NPI Number | 1659183135 |
|---|---|
| Provider Enumeration Date | 01/22/2025 |
| Last Update Date | 01/22/2025 |
| Medicare PECOS PAC ID | 4183145683 |
|---|---|
| Medicare Enrollment ID | O20250312001828 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659183135 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 208600000X | Surgery | (* (Not Available)) | Primary |
| Provider Name | Randall J Davault |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1457491904 PECOS PAC ID: 9739257395 Enrollment ID: I20081009000060 |
| Provider Name | Ashley R Smalling |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467860189 PECOS PAC ID: 0042430191 Enrollment ID: I20141013001756 |
| Provider Name | Tabitha Nave |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376068460 PECOS PAC ID: 0143595470 Enrollment ID: I20171012000267 |
| Provider Name | Michael Glen Cranford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1528553153 PECOS PAC ID: 0749516177 Enrollment ID: I20191118000683 |
| Provider Name | Bailey Buck |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457978934 PECOS PAC ID: 1850708280 Enrollment ID: I20210828000081 |
Marshall County Hma Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 907 Hospital Dr, Madill, OK 73446 Phone: 580-795-0191 | |
Osu Center For Health Sciences Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 901 S 5th Ave, Madill, OK 73446 Phone: 918-561-8306 Fax: 918-280-1917 | |
Marshall County Hma, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 Hospital Drive, Madill, OK 73446 Phone: 580-795-0191 | |
Legacy Family Medicine Pllc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 E Taliaferro St, Madill, OK 73446 Phone: 580-677-9500 | |
Marshall County Hmpn, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2 Hospital Drive, Madill, OK 73446 Phone: 580-795-0191 | |
Baptist Healthcare Of Oklahoma Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2 Hospital Dr, Madill, OK 73446 Phone: 580-795-0191 Fax: 580-795-0194 |