| Williams Medical Group Practice, Llc | |
|
4296 N Harrison St Shawnee OK 74804-1413 | |
| (405) 788-4102 | |
| Not Available |
| Full Name | Williams Medical Group Practice, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4296 N Harrison St, Shawnee, Oklahoma |
| Authorized Official Name and Position | Grant Asay (CEO) |
| Authorized Official Contact | 4054451210 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Williams Medical Group Practice, Llc 701 Cedar Lake Blvd Ste 160 Oklahoma City OK 73114-7818 Ph: (405) 445-1210 | Williams Medical Group Practice, Llc 4296 N Harrison St Shawnee OK 74804-1413 Ph: (405) 788-4102 |
| NPI Number | 1184294910 |
|---|---|
| Provider Enumeration Date | 06/24/2021 |
| Last Update Date | 02/24/2023 |
| Medicare PECOS PAC ID | 3375832157 |
|---|---|
| Medicare Enrollment ID | O20210723001093 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184294910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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