| Charger Health Group Pllc | |
|
511 N Aspen Ave Broken Arrow OK 74012-2220 | |
| (918) 806-8050 | |
| (918) 806-8090 |
| Full Name | Charger Health Group Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 511 N Aspen Ave, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Dennis S Blackstad (OWNER) |
| Authorized Official Contact | 9186056582 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charger Health Group Pllc Po Box 342 Broken Arrow OK 74013-0342 Ph: (918) 605-6582 | Charger Health Group Pllc 511 N Aspen Ave Broken Arrow OK 74012-2220 Ph: (918) 806-8050 |
| NPI Number | 1346855640 |
|---|---|
| Provider Enumeration Date | 09/14/2020 |
| Last Update Date | 09/22/2020 |
| Medicare PECOS PAC ID | 0941610240 |
|---|---|
| Medicare Enrollment ID | O20201027002200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346855640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Dennis S Blackstad |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710040894 PECOS PAC ID: 3678526969 Enrollment ID: I20050228000026 |
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