MEDICINE WHEEL INC (NPI# 1477899532) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477899532 |
| Entity Type | Organization |
| Organization Name | MEDICINE WHEEL INC |
| Other Organization Name | CADDO FAMILY MEDICINE CLINIC |
| Practice Address |
128 Buffalo Street Caddo OK 74729 |
| Mailing Address |
Po Box 146 Caddo OK 74729-0146 |
| Practice Telephone | 5803672100 |
| Practice Fax Number | 5803672103 |
| Mailing Telephone | 5803672100 |
| Mailing Fax Number | 5803672103 |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2014-05-20 |
| Authorized Official Name | PAUL E WEATHERS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 5803672100 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 2982 | OK | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 2982 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200328450B | 05 | |
| OK | 200328450A | 05 |
| Other Name | Type Code |
|---|---|
| Caddo Family Medicine Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285978007 | Medicine Wheel Inc | Emergency Medicine | 128 Buffalo Street, Caddo, OK 74729 | 2012-11-16 |
| 1598054330 | Medicine Wheel Inc | Emergency Medicine | 104 West F Street, Milburn, OK 73450 | 2011-04-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | MEDICINE WHEEL INC | 128 Buffalo Street, Caddo, OK 74729-2606 |
| Street Address |
128 BUFFALO STREET |
| City | CADDO |
| State | OK |
| Zip Code | 74729 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285978007 | Medicine Wheel Inc | Emergency Medicine | 128 Buffalo Street, Caddo, OK 74729 | 2012-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760721294 | Emily Ruth Love | Nurse Practitioner | 128 Buffalo St., Caddo, OK 74729 | 2013-02-04 |
| 1629452933 | Alicia Pettett | Speech-Language Pathologist | 600 S Mcpherren Street, Caddo, OK 74729-0128 | 2015-07-16 |
| 1033251525 | Bryan County School District I5 | Local Education Agency (LEA) | 600 S Mcpheron, Caddo, OK 74729-0128 | 2007-02-13 |
| 1821413501 | Tina Renee Harrison | Nurse Practitioner | 128 Buffalo Stree, Caddo, OK 74729-0146 | 2014-03-04 |
| 1730560459 | Jennifer Green | Case Manager/Care Coordinator | 610 Russell Rd, Caddo, OK 74729-1111 | 2015-06-18 |
| 1225357858 | Dion Lynore Martin | Counselor | 529 Hope Cir # 17, Caddo, OK 74729-1800 | 2010-05-21 |
| 1053639278 | Dana Melynda Blackwell | Behavioral Analyst | 6544 Nails Crossing Rd, Caddo, OK 74729-2016 | 2010-05-12 |
| 1154733293 | Onesource LLC | Pharmacy | 124 Buffalo St, Caddo, OK 74729-2606 | 2014-05-23 |
| 1033354121 | Kari Kamay Harrison | Registered Nurse | 138 Freeny Valley Rd, Caddo, OK 74729-2607 | 2008-12-04 |
| 1598213308 | Alyssa Michelle Hamilton | Case Manager/Care Coordinator | 4036 Caddo Hills Rd, Caddo, OK 74729-3625 | 2016-09-21 |
| Find all providers in zip 74729 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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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.