MEDICARE: MADELINE BACH

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	363L00000X	Nurse Practitioner	106661	OK

General Provider Information

NPI Number	:	1790230985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE BACH

Provider Business Mailing Address
First Line	:	800 NW 9TH ST STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7248
Country	:	US
Telephone Number	:	405-815-5050
Fax Number	:	405-815-5051

Provider Business Practice Location Address
First Line	:	800 NW 9TH ST STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-7248
Country	:	US
Telephone Number	:	405-815-5050
Fax Number	:	405-815-5051

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

Provider Enumeration Date	:	08/17/2016
Last Update Date	:	09/28/2022

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Directions to “ MADELINE BACH ” Practice Location

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