MEDICARE: AMBER MARIE MEIWES PA-C

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	363A00000X	Physician Assistant	2256	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	.	OTHER	OK	.

General Provider Information

NPI Number	:	1639411630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MARIE MEIWES PA-C

Provider Business Mailing Address
First Line	:	14024 QUAIL POINTE DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73134-1006
Country	:	US
Telephone Number	:	405-419-8465
Fax Number	:	405-419-7745

Provider Business Practice Location Address
First Line	:	63 GOODER SIMPSON BLVD
Second Line	:
City	:	PIEDMONT
State	:	OK
Zip	:	73078-9215
Country	:	US
Telephone Number	:	405-373-0380
Fax Number	:	405-373-0457

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

Provider Enumeration Date	:	03/18/2013
Last Update Date	:	07/14/2021

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