| Sooner Internal Medicine, Llc | |
|
1002 Mc Intosh Cir Suite 1 Joplin MO 64804-3642 | |
| (417) 781-0224 | |
| (417) 781-0692 |
| Full Name | Sooner Internal Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1002 Mc Intosh Cir, Joplin, Missouri |
| Authorized Official Name and Position | Randy Eugene Bowles (OWNER) |
| Authorized Official Contact | 4177810224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sooner Internal Medicine, Llc 1002 Mc Intosh Cir Suite 1 Joplin MO 64804-3642 Ph: (417) 781-0224 | Sooner Internal Medicine, Llc 1002 Mc Intosh Cir Suite 1 Joplin MO 64804-3642 Ph: (417) 781-0224 |
| NPI Number | 1154354835 |
|---|---|
| Provider Enumeration Date | 07/08/2006 |
| Last Update Date | 11/17/2009 |
| Medicare PECOS PAC ID | 9032292040 |
|---|---|
| Medicare Enrollment ID | O20080214000277 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154354835 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2001017184 (Missouri) | Primary |
| Provider Name | Randy Bowles |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851332860 PECOS PAC ID: 6406851526 Enrollment ID: I20060925000204 |
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