| Cedar Ridge Clinic,p.c. | |
| 
					10016 S Mingo Rd Ste A Tulsa OK 74133-5789  | |
| (918) 459-0583 | |
| (918) 250-0120 | 
| Full Name | Cedar Ridge Clinic,p.c. | 
|---|---|
| Speciality | Family Medicine | 
| Location | 10016 S Mingo Rd Ste A, Tulsa, Oklahoma | 
| Authorized Official Name and Position | Trung H Pham (PHYSICIAN) | 
| Authorized Official Contact | 9184590583 | 
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Cedar Ridge Clinic,p.c. 10016 S Mingo Rd Ste A Tulsa OK 74133-5789 Ph: (918) 459-0583  | Cedar Ridge Clinic,p.c. 10016 S Mingo Rd Ste A Tulsa OK 74133-5789 Ph: (918) 459-0583  | 
| NPI Number | 1366754202 | 
|---|---|
| Provider Enumeration Date | 07/08/2010 | 
| Last Update Date | 11/23/2010 | 
| Medicare PECOS PAC ID | 7810179546 | 
|---|---|
| Medicare Enrollment ID | O20110316000654 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1366754202 | NPI | - | NPPES | 
| 100223040F | Medicaid | OK | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207Q00000X | Family Medicine | 3313 (Oklahoma) | Primary | 
| Provider Name | Trung H Pham | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1700851052 PECOS PAC ID: 0648176925 Enrollment ID: I20031209000110  | 
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