MEDICARE: MCBRIDE CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225X00000X	Occupational Therapist
2	363A00000X	Physician Assistant
3	207RR0500X	Rheumatology Physician
4	208100000X	Physical Medicine & Rehabilitation Physician
5	207Q00000X	Family Medicine Physician
6	363L00000X	Nurse Practitioner
7	213E00000X	Podiatrist
8	225100000X	Physical Therapist
9	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1053319889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCBRIDE CLINIC INC

Provider Business Mailing Address
First Line	:	PO BOX 268981
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73126-8981
Country	:	US
Telephone Number	:	405-230-9000
Fax Number	:	405-230-9175

Provider Business Practice Location Address
First Line	:	1110 N LEE AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-2612
Country	:	US
Telephone Number	:	405-230-9000
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARK GALLIART
Credential	:
Telephone Number	:	405-230-9000

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	01/07/2011

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Directions to “MCBRIDE CLINIC INC ” Practice Location

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