| Shoolin LLC | |
|
105 S Bryant Ave Ste 101 Edmond OK 73034-6330 | |
| (405) 861-0004 | |
| (855) 680-8890 |
| Full Name | Shoolin LLC |
|---|---|
| Speciality | Hospitalist |
| Location | 105 S Bryant Ave Ste 101, Edmond, Oklahoma |
| Authorized Official Name and Position | Rakesh Shrivastava (OWNER) |
| Authorized Official Contact | 4056428613 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shoolin LLC Po Box 8350 Edmond OK 73083-8350 Ph: (405) 861-0004 | Shoolin LLC 105 S Bryant Ave Ste 101 Edmond OK 73034-6330 Ph: (405) 861-0004 |
| NPI Number | 1972012722 |
|---|---|
| Provider Enumeration Date | 09/25/2017 |
| Last Update Date | 02/16/2022 |
| Certification Date | 02/16/2022 |
| Medicare PECOS PAC ID | 0840566881 |
|---|---|
| Medicare Enrollment ID | O20171019000878 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972012722 | NPI | - | NPPES |
| Provider Name | Rakesh Shrivastava |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1043250863 PECOS PAC ID: 2466354063 Enrollment ID: I20100923000332 |
| Provider Name | Monica Tubbesing |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063876985 PECOS PAC ID: 0446532428 Enrollment ID: I20170127000397 |
| Provider Name | Robin Ann Whittenburg |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1598434714 PECOS PAC ID: 0244638062 Enrollment ID: I20211008002000 |
| Provider Name | Elizabeth Ann Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184121907 PECOS PAC ID: 4284068529 Enrollment ID: I20241016001624 |
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