| Northeast Oklahoma Physician Network Inc | |
|
1130 E Lansing St Broken Arrow OK 74012-2429 | |
| (918) 258-9990 | |
| (918) 994-4277 |
| Full Name | Northeast Oklahoma Physician Network Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 1130 E Lansing St, Broken Arrow, Oklahoma |
| Authorized Official Name and Position | Richard Ferguson (CEO) |
| Authorized Official Contact | 9184775049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northeast Oklahoma Physician Network Inc 2408 E 81st St Ste 300 Tulsa OK 74137-4200 Ph: (918) 477-5049 | Northeast Oklahoma Physician Network Inc 1130 E Lansing St Broken Arrow OK 74012-2429 Ph: (918) 258-9990 |
| NPI Number | 1114283025 |
|---|---|
| Provider Enumeration Date | 04/04/2012 |
| Last Update Date | 06/19/2012 |
| Medicare PECOS PAC ID | 8527224252 |
|---|---|
| Medicare Enrollment ID | O20120725000427 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114283025 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Scott J Fowler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952563892 PECOS PAC ID: 6709942063 Enrollment ID: I20090311000646 |
| Provider Name | Clell W Pond |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093795510 PECOS PAC ID: 5890848543 Enrollment ID: I20090729000227 |
| Provider Name | Kristina Kay Price |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295964823 PECOS PAC ID: 0648319574 Enrollment ID: I20091205000034 |
| Provider Name | William Daniel Vaughn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558809434 PECOS PAC ID: 2860778206 Enrollment ID: I20170419000757 |
| Provider Name | Kimberly Ann Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841749439 PECOS PAC ID: 1759658883 Enrollment ID: I20170522000745 |
| Provider Name | Keri Enns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417470006 PECOS PAC ID: 8022382399 Enrollment ID: I20170926000411 |
| Provider Name | Adrian Theerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295375996 PECOS PAC ID: 0547699746 Enrollment ID: I20200409002891 |
| Provider Name | Leticia Enriquez Rojas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164978045 PECOS PAC ID: 8224314554 Enrollment ID: I20210818002359 |
| Provider Name | Leisha Lynn Lawson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326519349 PECOS PAC ID: 9436491602 Enrollment ID: I20211029001754 |
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