| J Coffey Md Pc | |
|
1900 W 2nd St Suite C Elk City OK 73644-4328 | |
| (580) 225-9222 | |
| (580) 225-1027 |
| Full Name | J Coffey Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1900 W 2nd St, Elk City, Oklahoma |
| Authorized Official Name and Position | Sally Ann Coffey (OFFICE MANAGER) |
| Authorized Official Contact | 5802259222 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| J Coffey Md Pc 1900 W 2nd St Suite C Elk City OK 73644-4328 Ph: (580) 225-9222 | J Coffey Md Pc 1900 W 2nd St Suite C Elk City OK 73644-4328 Ph: (580) 225-9222 |
| NPI Number | 1386755072 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 10/17/2014 |
| Medicare PECOS PAC ID | 8628173556 |
|---|---|
| Medicare Enrollment ID | O20070420000226 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386755072 | NPI | - | NPPES |
| 100136650A | Medicaid | OK | |
| 20836 | Other | OK | MEDICAL LICENSE NUMBER |
| 37D0963547 | Other | OK | CLIA WAIVER NUMBER |
| 448604592-001 | Other | OK | BC BS OF OK PROVIDER ID |
| 100136650D | Medicaid | OK | |
| 100136650C | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20836 (Oklahoma) | Primary |
| Provider Name | J C Coffey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013045913 PECOS PAC ID: 9234162132 Enrollment ID: I20070420000214 |
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