MEDICARE: MARY GODINICH PA-C

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	363A00000X	Physician Assistant	5689	OK

General Provider Information

NPI Number	:	1902624265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY GODINICH PA-C

Provider Business Mailing Address
First Line	:	945 NE 16TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73104-4609
Country	:	US
Telephone Number	:	405-623-7848
Fax Number	:

Provider Business Practice Location Address
First Line	:	11011 HEFNER POINTE DR STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-5005
Country	:	US
Telephone Number	:	405-479-8300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2024
Last Update Date	:	01/09/2026

Similar Medicare Providers

1649326950 — RUSSELL D CRAIN MD PC
Practice Location Address:

11011 HEFNER POINTE DR STE B
OKLAHOMA CITY, OK
73120-5005

Practice Phone: 573-381-0305
Practice Fax: 405-751-8894

1629091517 — DR. RUSSELL DEAN CRAIN MD
Practice Location Address:

11011 HEFNER POINTE DR STE B
OKLAHOMA CITY, OK
73120-5005

Practice Phone: 405-749-9399
Practice Fax: 405-751-8894

1184580532 — LAKESIDE PEDIATRICS PC
Practice Location Address:

11011 HEFNER POINTE DR STE A
OKLAHOMA CITY, OK
73120-5005

Practice Phone: 405-479-8300
Practice Fax: 405-212-3606

1124005533 — KEVIN MICHAEL MCMULLEN MD PLLC
Practice Location Address:

11011 HEFNER POINTE DR , SUITE A
OKLAHOMA CITY, OK
73120-5005

Practice Phone: 405-749-8346
Practice Fax: 405-749-8349

1366751612 — CRAIN OPTICAL LLC
Practice Location Address:

11011 HEFNER POINTE DR , SUITE B
OKLAHOMA CITY, OK
73120-5005

Practice Phone: 405-749-9399
Practice Fax: 405-751-8894

1962471813 — JOAN T MERRILL MD
Practice Location Address:

825 NE 13TH ST , OMRF E110
OKLAHOMA CITY, OK
73104-5005

Practice Phone: 405-271-7805
Practice Fax:

Directions to “ MARY GODINICH PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.