MEDICARE: MARCHEL WORD CLEMENTS D.O.

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	207X00000X	Orthopaedic Surgery Physician	2945	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5454227	OTHER	CIGNA
3	5932735	OTHER	AETNA

General Provider Information

NPI Number	:	1386672913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCHEL WORD CLEMENTS D.O.

Provider Business Mailing Address
First Line	:	4802 S 109TH EAST AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74146-5822
Country	:	US
Telephone Number	:	918-392-1400
Fax Number	:	918-392-1488

Provider Business Practice Location Address
First Line	:	4812 S 109TH EAST AVE
Second Line	:	STE. 300
City	:	TULSA
State	:	OK
Zip	:	74146-5826
Country	:	US
Telephone Number	:	918-236-4580
Fax Number	:	918-236-4587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	11/14/2016

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