| Id Consultants Pllc | |
|
8609 Willow Springs Ct Broken Arrow OK 74011-8250 | |
| (918) 361-2825 | |
| (770) 573-9513 |
| Full Name | Id Consultants Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 8609 Willow Springs Ct, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Shaun White (MANAGER) |
| Authorized Official Contact | 5022129393 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Id Consultants Pllc 8609 Willow Springs Ct Broken Arrow OK 74011-8250 Ph: (918) 361-2825 | Id Consultants Pllc 8609 Willow Springs Ct Broken Arrow OK 74011-8250 Ph: (918) 361-2825 |
| NPI Number | 1932507605 |
|---|---|
| Provider Enumeration Date | 12/12/2014 |
| Last Update Date | 02/12/2015 |
| Medicare PECOS PAC ID | 2961727656 |
|---|---|
| Medicare Enrollment ID | O20150223000663 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932507605 | NPI | - | NPPES |
| 200037750A | Medicaid | OK | |
| 24139 | Other | OK | STATE LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | 24139 (Oklahoma) | Primary |
| Provider Name | Debra L Murray |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1215912621 PECOS PAC ID: 2961487129 Enrollment ID: I20041016000232 |
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