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NPI Code Detail

MEDICARE: TINA C SMALL MD

MEDICARE: TINA C SMALL MD
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
1208100000XPhysical Medicine & Rehabilitation Physician24054OK

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00166228OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2487023200OTHEROKDOL
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
47664685OTHEROKAETNA

General Provider Information

NPI Number : 1720074255
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA C SMALL MD
Provider Business Mailing Address
First Line : 4301 WILSON ST
Second Line :
City : FORT SILL
State : OK
Zip : 73503-4472
Country : US
Telephone Number : 580-558-8497
Fax Number : 580-429-0819
Provider Business Practice Location Address
First Line : 4301 WILSON ST
Second Line :
City : FORT SILL
State : OK
Zip : 73503-4472
Country : US
Telephone Number : 580-558-8497
Fax Number : 580-558-3323
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 01/03/2024

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