Healthcare Provider Details

I. General information

NPI: 1174095038
Provider Name (Legal Business Name): NEUROPATHY TREATMENTS OF MCALESTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E CARL ALBERT PKWY # D1
MCALESTER OK
74501-5061
US

IV. Provider business mailing address

320 E CARL ALBERT PKWY # B1
MCALESTER OK
74501-5061
US

V. Phone/Fax

Practice location:
  • Phone: 918-426-6005
  • Fax:
Mailing address:
  • Phone: 918-426-6005
  • Fax: 918-426-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDY BAHE
Title or Position: MANAGING MEMBER
Credential:
Phone: 918-426-6005