MEDICARE: CAREATC-OKC CARE

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1639621246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREATC-OKC CARE

Provider Business Mailing Address
First Line	:	424 COLCORD DR
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-2215
Country	:	US
Telephone Number	:	800-993-8244
Fax Number	:

Provider Business Practice Location Address
First Line	:	424 COLCORD DR
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-2215
Country	:	US
Telephone Number	:	800-993-8244
Fax Number	:

Authorized Official
Title or Position	:	DIR OF FACILITIES AND PURCHASING
Name	:	KEITH GUCWA
Credential	:
Telephone Number	:	918-779-7416

Provider Enumeration Date	:	10/30/2016
Last Update Date	:	10/30/2016

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