| Pathways Medical Llc | |
|
13707 Fairhill Ave Edmond OK 73013 | |
| (405) 607-4041 | |
| (405) 463-0090 |
| Full Name | Pathways Medical Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13707 Fairhill Ave, Edmond, Oklahoma |
| Authorized Official Name and Position | Zachory Randall (CEO/PRESIDENT) |
| Authorized Official Contact | 4056074041 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pathways Medical Llc 13707 Fairhill Ave Edmond OK 73013 Ph: (405) 607-4041 | Pathways Medical Llc 13707 Fairhill Ave Edmond OK 73013 Ph: (405) 607-4041 |
| NPI Number | 1194185090 |
|---|---|
| Provider Enumeration Date | 03/04/2016 |
| Last Update Date | 05/18/2021 |
| Medicare PECOS PAC ID | 6901192046 |
|---|---|
| Medicare Enrollment ID | O20160915001575 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194185090 | NPI | - | NPPES |
| 200640210A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | James Thomas Cail |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669403085 PECOS PAC ID: 8426082264 Enrollment ID: I20080530000707 |
| Provider Name | Barome Enoweyere |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992381982 PECOS PAC ID: 7911347851 Enrollment ID: I20240425003095 |
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