MEDICARE: RHEUMATIC DISEASES CLINIC OF OKLAHOMA, 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	174400000X	Specialist	22765	OK

General Provider Information

NPI Number	:	1942691175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHEUMATIC DISEASES CLINIC OF OKLAHOMA, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 2237
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73101-2237
Country	:	US
Telephone Number	:	405-606-8070
Fax Number	:	405-606-6350

Provider Business Practice Location Address
First Line	:	1015 N SHARTEL AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73102-1021
Country	:	US
Telephone Number	:	405-606-8070
Fax Number	:	405-606-6350

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. RONDA KAY BERENS
Credential	:
Telephone Number	:	405-323-7134

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	09/02/2025

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