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General NPI Number Information
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NPI Number | 1790278406
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Entity Type | Organization
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Legal Business Name | COHESIVE MEDICAL CLINIC CARNEGIE
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 101 ASH ST
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City | CARNEGIE
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State | OK
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Zip | 73015
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Country | US
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Telephone | 580-654-1154
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Fax |
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Provider Business Mailing Address
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Address Line | 101 ASH ST
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City | CARNEGIE
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State | OK
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Zip | 73015
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Country | US
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Telephone | 580-654-1154
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF STRATEGIC INIATIATIVES
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Name | JAMAL BANDEH
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Credential |
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Telephone | 918-269-1722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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