| Premise Health Of Oklahoma Medical Pc | |
|
101 N Robinson Ave Ste 200 Oklahoma City OK 73102-5502 | |
| (405) 552-6110 | |
| Not Available |
| Full Name | Premise Health Of Oklahoma Medical Pc |
|---|---|
| Speciality | Clinic/Center |
| Location | 101 N Robinson Ave Ste 200, Oklahoma City, Oklahoma |
| Authorized Official Name and Position | Jonathan Leizman (PRESIDENT) |
| Authorized Official Contact | 2164799063 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premise Health Of Oklahoma Medical Pc 5500 Maryland Way Brentwood TN 37027-7048 Ph: () - | Premise Health Of Oklahoma Medical Pc 101 N Robinson Ave Ste 200 Oklahoma City OK 73102-5502 Ph: (405) 552-6110 |
| NPI Number | 1902475957 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 02/24/2025 |
| Medicare PECOS PAC ID | 4587619697 |
|---|---|
| Medicare Enrollment ID | O20050322000100 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902475957 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Steven Earl Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457327470 PECOS PAC ID: 0143366013 Enrollment ID: I20091006000695 |
| Provider Name | Kasey Lee Choate |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952819195 PECOS PAC ID: 9739576042 Enrollment ID: I20220504002530 |
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