| Shawnee Family Medicine Clinic | |
|
2400 N Harrison St Shawnee OK 74804-3133 | |
| (405) 395-4441 | |
| (405) 438-0540 |
| Full Name | Shawnee Family Medicine Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 2400 N Harrison St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Rodney Omar Mccrory (PARTNER-PROVIDER) |
| Authorized Official Contact | 4053954441 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Family Medicine Clinic 2400 N Harrison St Shawnee OK 74804-3133 Ph: (405) 395-4441 | Shawnee Family Medicine Clinic 2400 N Harrison St Shawnee OK 74804-3133 Ph: (405) 395-4441 |
| NPI Number | 1518559368 |
|---|---|
| Provider Enumeration Date | 02/03/2021 |
| Last Update Date | 06/17/2021 |
| Certification Date | 06/17/2021 |
| Medicare PECOS PAC ID | 9436566007 |
|---|---|
| Medicare Enrollment ID | O20210513001692 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518559368 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 261QP2300X | Clinic/center - Primary Care | () | Secondary |
| Provider Name | Jeanie Johnson Simpson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1225094626 PECOS PAC ID: 6305857707 Enrollment ID: I20060526000101 |
| Provider Name | Rodney O Mccrory |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407815368 PECOS PAC ID: 6406867753 Enrollment ID: I20100420000130 |
| Provider Name | Shannon Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912653221 PECOS PAC ID: 4587050802 Enrollment ID: I20220413000493 |
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