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NPI Code Detail

MEDICARE: ALLCARE GROUP PLLC

MEDICARE: ALLCARE GROUP 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
1363AM0700XMedical Physician Assistant1327OK
2207Q00000XFamily Medicine Physician3650OK

General Provider Information

NPI Number : 1679871610
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALLCARE GROUP PLLC
Provider Business Mailing Address
First Line : PO BOX 1109
Second Line :
City : SAPULPA
State : OK
Zip : 74067-1109
Country : US
Telephone Number : 918-216-4006
Fax Number : 918-216-4007
Provider Business Practice Location Address
First Line : 730 E TAFT AVE
Second Line :
City : SAPULPA
State : OK
Zip : 74066-5766
Country : US
Telephone Number : 918-216-4006
Fax Number : 918-216-4007
Authorized Official
Title or Position : OWNER
Name : DENNIS S BLACKSTAD
Credential : D.O.
Telephone Number : 918-216-4006
Provider Enumeration Date : 02/28/2011
Last Update Date : 08/03/2023

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