PAWNEE HEALTH & WELLNESS CLINIC LLC (NPI# 1174892590) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174892590 |
| Entity Type | Organization |
| Organization Name | PAWNEE HEALTH & WELLNESS CLINIC LLC |
| Practice Address |
304 Boulder St Pawnee OK 74058-4028 |
| Practice Telephone | 9187623601 |
| Practice Fax Number | 9187622544 |
| Mailing Telephone | 9187623601 |
| Mailing Fax Number | 9187622544 |
| Enumeration Date | 2011-12-14 |
| Last Update Date | 2012-04-05 |
| Authorized Official Name | DR. GORDON PAGE LAIRD (OWNER) |
| Authorized Official Telephone | 9187623601 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363A00000X | Physician Assistant | PA763 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 208D00000X | General Practice | OK1532 | OK | Allopathic & Osteopathic Physicians |
| Street Address |
304 BOULDER ST |
| City | PAWNEE |
| State | OK |
| Zip Code | 74058-4028 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619954088 | Gordon P Laird | Surgery | 304 Boulder St, Pawnee, OK 74058-4028 | 2005-12-28 |
| 1871039396 | Northern Oklahoma Addiction Clinic | Clinic/Center | 304 Boulder St, Pawnee, OK 74058-4028 | 2017-01-08 |
| 1295283018 | Pain Relief Center of Oklahoma | Anesthesiology | 304 Boulder St, Pawnee, OK 74058-4028 | 2016-09-21 |
| 1578011565 | Gateway Addiction Center LLC | Physician Assistant | 304 Boulder St, Pawnee, OK 74058-4028 | 2016-09-19 |
| 1942472311 | Gordon P Laird,do | Family Medicine | 304 Boulder St, Pawnee, OK 74058-4028 | 2008-03-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316214430 | Tonya L Houston | Nurse Practitioner | Pawnee Indian Health Center, 1201 Heritage Cir, Pawnee, OK 74058 | 2011-11-17 |
| 1659662153 | Christie Factor | Counselor | 540 Illinois, Pawnee, OK 74058 | 2011-05-02 |
| 1366476368 | Henry J Kaehler Jr Dds PC | Clinic/Center | 401 Forest St, Pawnee, OK 74058 | 2006-07-10 |
| 1003892621 | Brady Gene Englestead | Pediatrics | 1201 Heritage Circle, Pawnee, OK 74058 | 2005-12-15 |
| 1598039620 | Cah Acquisition Company 12 LLC | Clinic/Center | 535 6th St, Pawnee, OK 74058 | 2012-03-07 |
| 1639453665 | Creoks Mental Health Services | Community/Behavioral Health | 540 Illinois St, Pawnee, OK 74058 | 2011-10-10 |
| 1659473080 | Henry John Kaehler Jr. | Dentist | 401 Forest St, Pawnee, OK 74058 | 2006-09-05 |
| 1578503611 | William Lester Carruth | Dentist | 481 Agency Road, Pawnee, OK 74058-0130 | 2006-06-07 |
| 1821275744 | Patsy Ann Cooper | Counselor | 540 Illinois St, Pawnee, OK 74058-2036 | 2008-01-22 |
| 1225158314 | Cockrell Eyecare Center | Optometrist | 534 Illinois St, Pawnee, OK 74058-2036 | 2007-03-30 |
| Find all providers in zip 74058 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205208535 | Phoenix Medical Center | General Practice | 557 Harrison St, Pawnee, OK 74058-2566 | 2015-10-26 |
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|---|---|---|---|---|
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| 1801431135 | Cristina Elisa Collazo-suarez | General Practice | 401 Nw 76th St, Lawton, OK 73505-5338 | 2019-11-11 |
| 1578117859 | Tulsa Wellness Management, LLC | General Practice | 3501 S Yale Ave Ste A, Tulsa, OK 74135-8014 | 2019-07-25 |
| 1053875781 | Oumi Clinics LLC | General Practice | 1200 Childrens Ave Ste 11200, Oklahoma City, OK 73104-4637 | 2019-01-28 |
| 1902396294 | Gail Renee Marchant | General Practice | 8784 E 105th Ct, Tulsa, OK 74133-7063 | 2018-05-13 |
| 1528578499 | Revive Medical LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118 | 2017-10-05 |
| 1992214548 | Lifestyle Medical Center, Pllc | General Practice | 4505 S Harvard Ave, Tulsa, OK 74135-2905 | 2017-09-27 |
| 1265884449 | Turning Point Health LLC | General Practice | 736 W Main St, Jenks, OK 74037-3519 | 2016-07-12 |
| 1891149647 | Daniel Enriquez | General Practice | 1040 7050 S Air Depot Blvd, Oklahoma City, OK 73135 | 2016-04-18 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.