MEDICARE: NR SOUTHWEST OKC LLC

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
2	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1598480220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NR SOUTHWEST OKC LLC

Provider Business Mailing Address
First Line	:	3705 NW 63RD ST STE 200
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1937
Country	:	US
Telephone Number	:	405-953-7221
Fax Number	:

Provider Business Practice Location Address
First Line	:	9821 S MAY AVE STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7042
Country	:	US
Telephone Number	:	405-495-7391
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TIMOTHY C BALES
Credential	:	OWNER/CEO
Telephone Number	:	405-953-7221

Provider Enumeration Date	:	10/05/2022
Last Update Date	:	03/03/2025

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Directions to “NR SOUTHWEST OKC LLC ” Practice Location

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