| Family Medicine Associates Of Edmond Llc | |
|
105 S Bryant Ave Ste 210 Edmond OK 73034-6331 | |
| (405) 359-5229 | |
| (405) 359-5214 |
| Full Name | Family Medicine Associates Of Edmond Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 105 S Bryant Ave Ste 210, Edmond, Oklahoma |
| Authorized Official Name and Position | Stephanie Jones (DIRECTOR OF PATIENT ACCOUNTING) |
| Authorized Official Contact | 4052717099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Associates Of Edmond Llc Po Box 744499 Atlanta GA 30374-4499 Ph: (405) 271-8132 | Family Medicine Associates Of Edmond Llc 105 S Bryant Ave Ste 210 Edmond OK 73034-6331 Ph: (405) 359-5229 |
| NPI Number | 1093940454 |
|---|---|
| Provider Enumeration Date | 05/28/2009 |
| Last Update Date | 07/15/2019 |
| Medicare PECOS PAC ID | 4688727407 |
|---|---|
| Medicare Enrollment ID | O20090727000630 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093940454 | NPI | - | NPPES |
| 200249490A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Larry D Balzer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235129370 PECOS PAC ID: 7517940968 Enrollment ID: I20100729000165 |
| Provider Name | Michael Thrower |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366648859 PECOS PAC ID: 4880889682 Enrollment ID: I20101105000817 |
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