MEDICARE: DIRECT2U URGENT CARE PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1568920924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT2U URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	2417 COUNTY ROAD 1263
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-3123
Country	:	US
Telephone Number	:	405-274-5551
Fax Number	:

Provider Business Practice Location Address
First Line	:	2417 COUNTY ROAD 1263
Second Line	:
City	:	BLANCHARD
State	:	OK
Zip	:	73010-3123
Country	:	US
Telephone Number	:	405-274-5551
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DEANA M. WAGES
Credential	:
Telephone Number	:	405-274-5551

Provider Enumeration Date	:	03/05/2019
Last Update Date	:	03/19/2019

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