MEDICARE: PIC BARTLESVILLE, PLLC

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	16429	OK
2	261QU0200X	Urgent Care Clinic/Center	18176	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316952112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIC BARTLESVILLE, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1207
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53201-1207
Country	:	US
Telephone Number	:	815-713-2600
Fax Number	:	815-654-8020

Provider Business Practice Location Address
First Line	:	2334 SE WASHINGTON BLVD STE B&D
Second Line	:	PIC BARTLESVILLE PLLC
City	:	BARTLESVILLE
State	:	OK
Zip	:	74006-7256
Country	:	US
Telephone Number	:	918-331-9184
Fax Number	:	918-331-9187

Authorized Official
Title or Position	:	DIRECTOR / BILLING SERVICES
Name	:	MS. MONICA KLOSA
Credential	:
Telephone Number	:	815-713-2621

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	02/01/2010

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Directions to “PIC BARTLESVILLE, PLLC ” Practice Location

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