| Transformation Health PLLC | |
|
12142 S Yukon Ave Glenpool OK 74033 | |
| (918) 935-3636 | |
| (918) 296-7934 |
| Full Name | Transformation Health PLLC |
|---|---|
| Speciality | Family Medicine |
| Location | 12142 S Yukon Ave, Glenpool, Oklahoma |
| Authorized Official Name and Position | Chad Edwards (OWNER) |
| Authorized Official Contact | 9189353636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Transformation Health PLLC 12142 S Yukon Ave Glenpool OK 74033 Ph: (918) 935-3636 | Transformation Health PLLC 12142 S Yukon Ave Glenpool OK 74033 Ph: (918) 935-3636 |
| NPI Number | 1497263818 |
|---|---|
| Provider Enumeration Date | 01/19/2018 |
| Last Update Date | 11/08/2022 |
| Certification Date | 11/08/2022 |
| Medicare PECOS PAC ID | 3476895822 |
|---|---|
| Medicare Enrollment ID | O20190503001849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497263818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 208D00000X | General Practice | () | Secondary |
| Provider Name | Chad P Edwards |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790833481 PECOS PAC ID: 5991883621 Enrollment ID: I20111103000926 |
| Provider Name | Carissa Michelle Hines-lawson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1558730242 PECOS PAC ID: 3274932538 Enrollment ID: I20210519001227 |
| Provider Name | Benjamin Holler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1902335698 PECOS PAC ID: 1658621529 Enrollment ID: I20240422002778 |
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