| 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 |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
| Provider Name | Robert L Shepler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386604239 PECOS PAC ID: 5799686077 Enrollment ID: I20040119000785 |
| Provider Name | Douglas R Banning |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356477681 PECOS PAC ID: 6608863287 Enrollment ID: I20040427000371 |
| Provider Name | Rita S Westenhaver |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639141724 PECOS PAC ID: 8123071586 Enrollment ID: I20060504000488 |
| Provider Name | Kyra J Vineyard |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225005895 PECOS PAC ID: 8022014133 Enrollment ID: I20061012000644 |
| Provider Name | Barry Don Troutman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104910272 PECOS PAC ID: 6204996424 Enrollment ID: I20081118000599 |
| 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 | Jay A Geary |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821071036 PECOS PAC ID: 7810036639 Enrollment ID: I20091207000660 |
| Provider Name | Darci R Hazelwood |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417914961 PECOS PAC ID: 3971635863 Enrollment ID: I20100712000487 |
| Provider Name | Harleen Kaur Grewal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417926387 PECOS PAC ID: 1355466236 Enrollment ID: I20100915000868 |
| Provider Name | Ian D Bushyhead |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679701361 PECOS PAC ID: 8921143777 Enrollment ID: I20110915000808 |
| Provider Name | Monica Winford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679810295 PECOS PAC ID: 3971731886 Enrollment ID: I20140122000258 |
| Provider Name | Bryan D Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316343338 PECOS PAC ID: 7416272133 Enrollment ID: I20150220000822 |
| Provider Name | Kyndol M Ray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093151342 PECOS PAC ID: 6406090059 Enrollment ID: I20150324000664 |
| Provider Name | Sheila Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508224882 PECOS PAC ID: 2062718620 Enrollment ID: I20160308000288 |
| Provider Name | Clinton R Childs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841245024 PECOS PAC ID: 8123117744 Enrollment ID: I20160405002357 |
| Provider Name | William Daniel Vaughn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558809434 PECOS PAC ID: 2860778206 Enrollment ID: I20170419000757 |
| Provider Name | Betsy Graham-moeller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568992071 PECOS PAC ID: 6800160409 Enrollment ID: I20170920003016 |
| Provider Name | Keri Enns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417470006 PECOS PAC ID: 8022382399 Enrollment ID: I20170926000411 |
| Provider Name | Ted L Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407304827 PECOS PAC ID: 2062760028 Enrollment ID: I20180807003571 |
| Provider Name | Adrian Theerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295375996 PECOS PAC ID: 0547699746 Enrollment ID: I20200409002891 |
| Provider Name | Brandi S Shell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952916645 PECOS PAC ID: 6901218296 Enrollment ID: I20201210000546 |
| 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 |
| Provider Name | William Karl Thummel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639830573 PECOS PAC ID: 2860888344 Enrollment ID: I20220410000100 |
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