| Family Medicine Associates | |
|
3100 S. Elm Pl. Suite A Broken Arrow OK 74012-7910 | |
| (918) 455-7777 | |
| (918) 455-8105 |
| Full Name | Family Medicine Associates |
|---|---|
| Speciality | Family Medicine |
| Location | 3100 S. Elm Pl., Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Leroy O. Jeske (MEDICAL DIRECTOR D.O.) |
| Authorized Official Contact | 9184557777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Associates 3100 S. Elm Pl. Suite A Broken Arrow OK 74012-7910 Ph: (918) 455-7777 | Family Medicine Associates 3100 S. Elm Pl. Suite A Broken Arrow OK 74012-7910 Ph: (918) 455-7777 |
| NPI Number | 1053431452 |
|---|---|
| Provider Enumeration Date | 03/30/2007 |
| Last Update Date | 04/20/2008 |
| Medicare PECOS PAC ID | 2769675446 |
|---|---|
| Medicare Enrollment ID | O20101026001171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053431452 | NPI | - | NPPES |
| 0749960001 | Other | OK | PTAN/DMERC |
| CS2603 | Other | OK | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Bryan L Dalton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386647428 PECOS PAC ID: 3779647888 Enrollment ID: I20090203000712 |
| Provider Name | Athena C Mason |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437152774 PECOS PAC ID: 8224192331 Enrollment ID: I20101026001499 |
| Provider Name | Leroy O Jeske |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205839446 PECOS PAC ID: 4385623081 Enrollment ID: I20101026001518 |
| Provider Name | Tracy L Asher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366445405 PECOS PAC ID: 2668536772 Enrollment ID: I20101026001560 |
| Provider Name | Daniel L Wooster |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518960756 PECOS PAC ID: 7113081225 Enrollment ID: I20101026001566 |
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