PRAIRIE GARDENS MEDICAL LLC (NPI# 1669080891) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669080891 |
| Entity Type | Organization |
| Organization Name | PRAIRIE GARDENS MEDICAL LLC |
| Practice Address |
1213 Nw 122nd St Ste 401 Oklahoma City OK 73114-7000 |
| Mailing Address |
175 Lary Ln Guthrie OK 73044-6542 |
| Practice Telephone | 4059628123 |
| Practice Fax Number | 4059628125 |
| Mailing Telephone | 4059628123 |
| Mailing Fax Number | 4059628125 |
| Enumeration Date | 2020-07-14 |
| Last Update Date | 2020-09-16 |
| Authorized Official Name | DIANNE G TUPPER (MANAGING PARTNER) |
| Authorized Official Telephone | 4057428898 |
| Authorized Official Credential | RN/OPAC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689280067 | Prairie Gardens Medical LLC | General Practice | 1213 Nw 122nd St Ste 401, Oklahoma City, OK 73114-7000 | 2020-09-21 |
| Street Address |
1213 NW 122ND ST STE 401 |
| City | OKLAHOMA CITY |
| State | OK |
| Zip Code | 73114-7000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689280067 | Prairie Gardens Medical LLC | General Practice | 1213 Nw 122nd St Ste 401, Oklahoma City, OK 73114-7000 | 2020-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124669783 | Heather Williams | Occupational Therapist | 1404 Nw122nd St, Oklahoma City, OK 73114 | 2019-10-04 |
| 1477194033 | Shonta Jones | Technician | 10723 Norh Western, Apartment G, Oklahoma City, OK 73114 | 2019-10-04 |
| 1023537644 | Tracye Carter | Registered Nurse | 812 Nw 121 Terr, Oklahom City, OK 73114 | 2017-09-14 |
| 1003362849 | Randy Joshua Williamson | Behavioral Analyst | 101 Bainbridge Rd, Oklahoma City, OK 73114 | 2016-08-31 |
| 1427413368 | John Adrian Howard | Physical Therapist | 13100 N Western Ave Ste 302, Oklahoma City, OK 73114 | 2015-12-18 |
| 1497150197 | Payam Ishani Afousi | Dentist | 9405 N. Penn Place, Casady Square, Oklahoma City, OK 73114 | 2014-10-24 |
| 1922407386 | Kelvin Hughes | Counselor | 1400 Nw 105th Ter, Oklahoma City, OK 73114 | 2014-08-21 |
| 1285056887 | Malarie Jackson | Nurse Practitioner | 609 W. Memorial Rd., Oklahoma City, OK 73114 | 2014-01-16 |
| 1508108705 | Adam Liberty | Community/Behavioral Health | 428 N.w 81st, Oklahoma City, OK 73114 | 2013-03-26 |
| 1780926345 | Michelle D Hardimon | Behavioral Analyst | 700 Ne 122nd Apt 4509, Oklahoma City, OK 73114 | 2013-03-21 |
| Find all providers in zip 73114 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053875781 | Oumi Clinics LLC | General Practice | 1200 Childrens Ave Ste 11200, Oklahoma City, OK 73104-4637 | 2019-01-28 |
| 1528578499 | Revive Medical LLC | General Practice | 4215 N Classen Blvd Ste 103, Oklahoma City, OK 73118 | 2017-10-05 |
| 1891149647 | Daniel Enriquez | General Practice | 1040 7050 S Air Depot Blvd, Oklahoma City, OK 73135 | 2016-04-18 |
| 1669726188 | Arrrc, Inc. | General Practice | 2149 S.w. 59th St., Suite 105, Oklahoma City, OK 73119-7003 | 2012-11-06 |
| 1386932986 | George Fred Mcdonnold | General Practice | 2973 Rolling Stone Rd, Oklahoma City, OK 73120-1921 | 2011-07-16 |
| 1770877151 | Michael Shane Johnson | General Practice | 13600 Prairie View Ln, Oklahoma City, OK 73142-5917 | 2011-06-03 |
| 1295027647 | Albert T Nguyen | General Practice | 2636 Sw 28th St, Oklahoma City, OK 73108-5823 | 2011-05-04 |
| 1538458047 | Healthfirst Physician Management | General Practice | 1111 N Dewey, Pre-op Clinic, Oklahoma City, OK 73103 | 2011-04-05 |
| 1114154960 | Joshua Alan Stevens | General Practice | 301 Nw 6th St, Ste 150, Oklahoma City, OK 73102-2823 | 2009-06-19 |
| 1629226717 | Family Medical Office, LLC | General Practice | 9220 S Penn Ave, Suite A, Oklahoma City, OK 73159-6937 | 2008-09-03 |
| Find all providers in OKLAHOMA CITY | ||||
| City | OKLAHOMA CITY |
| Zip Code | 73114 |
Please comment or provide details below to improve the information on PRAIRIE GARDENS MEDICAL LLC.
| 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.