Healthcare Provider Details

I. General information

NPI: 1831399815
Provider Name (Legal Business Name): KROEKER MEDICAL INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST MAIN ST.
CHOUTEAU OK
74337
US

IV. Provider business mailing address

PO BOX 315
CHOUTEAU OK
74337-0315
US

V. Phone/Fax

Practice location:
  • Phone: 918-476-6030
  • Fax: 918-476-6038
Mailing address:
  • Phone: 918-476-6030
  • Fax: 918-476-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number4306
License Number StateOK

VIII. Authorized Official

Name: DR. CHERYL KROEKER
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 918-476-6030