MEDICARE: DYCUS-CAMP CLINIC INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1982896544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYCUS-CAMP CLINIC INC

Provider Business Mailing Address
First Line	:	320 N SERVICE RD
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-4945
Country	:	US
Telephone Number	:	405-794-4474
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 N SERVICE RD
Second Line	:
City	:	MOORE
State	:	OK
Zip	:	73160-4945
Country	:	US
Telephone Number	:	405-794-4474
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. SHELLEY R SHELTON
Credential	:
Telephone Number	:	405-794-4474

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	04/04/2013

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Directions to “DYCUS-CAMP CLINIC INC ” Practice Location

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