Healthcare Provider Details

I. General information

NPI: 1275670432
Provider Name (Legal Business Name): SERETEAN WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 W HALL OF FAME
STILLWATER OK
74078-0001
US

IV. Provider business mailing address

1514 W HALL OF FAME
STILLWATER OK
74078-0001
US

V. Phone/Fax

Practice location:
  • Phone: 405-744-6211
  • Fax: 405-744-8448
Mailing address:
  • Phone: 405-744-6211
  • Fax: 405-744-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOK

VIII. Authorized Official

Name: TAMMY SHAFFER
Title or Position: MEDICAL MANAGER COORDINATOR
Credential:
Phone: 405-744-6211