| Mission Street Medical Clinic Inc | |
|
615 S Mission St Ste A Sapulpa OK 74066-4635 | |
| (918) 224-9555 | |
| (918) 224-8001 |
| Full Name | Mission Street Medical Clinic Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 615 S Mission St Ste A, Sapulpa, Oklahoma |
| Authorized Official Name and Position | Dianna M Willis (DOCTOR) |
| Authorized Official Contact | 9182249555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission Street Medical Clinic Inc 615 S Mission St Ste A Sapulpa OK 74066-4635 Ph: (918) 224-9555 | Mission Street Medical Clinic Inc 615 S Mission St Ste A Sapulpa OK 74066-4635 Ph: (918) 224-9555 |
| NPI Number | 1972600112 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 12/30/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972600112 | NPI | - | NPPES |
| 100739110A | Medicaid | OK | |
| C05052 | Other | OK | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2405 (Oklahoma) | Primary |
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