MEDICARE: SPECTRUM HEALTHCARE SOLUTIONS, 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	26716	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	193200000X	OTHER	OK	TAXONOMY CODE

General Provider Information

NPI Number	:	1558816850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECTRUM HEALTHCARE SOLUTIONS, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 6276
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73070-6276
Country	:	US
Telephone Number	:	405-768-5749
Fax Number	:	405-493-8506

Provider Business Practice Location Address
First Line	:	4220 N CLASSEN BLVD STE A
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-2434
Country	:	US
Telephone Number	:	405-769-5749
Fax Number	:	405-493-8506

Authorized Official
Title or Position	:	COO
Name	:	MICHELLE CLARK
Credential	:
Telephone Number	:	405-768-5749

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	02/18/2025

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