CHARLES R METTRY (NPI# 1871581470) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871581470 |
| Entity Type | Individual |
| Full Name | CHARLES R METTRY |
| Credential | D.O. |
| Practice Address |
201 N Monte Vista St Suite B Ada OK 74820-7200 |
| Mailing Address |
201 N Monte Vista St Suite B Ada OK 74820-7213 |
| Practice Telephone | 5804364200 |
| Practice Fax Number | 5804366423 |
| Mailing Telephone | 5804364200 |
| Mailing Fax Number | 5804366423 |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2009-08-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
2206 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 100111120A | 05 | |
| OK | FED ID | 38-2376906 | 01 |
| Street Address |
201 N MONTE VISTA ST SUITE B |
| City | ADA |
| State | OK |
| Zip Code | 74820-7200 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740644970 | Penni Cartlidge | Nurse Practitioner | 201 N Monte Vista St, Ada, OK 74820-7213 | 2016-04-13 |
| 1497186357 | Carpenter Clinic Pllc | Family Medicine | 201 N Monte Vista St, Ste A, Ada, OK 74820-7213 | 2013-12-03 |
| 1154489540 | Cms Outpatient Clinic Inc. | Family Medicine | 201 N Monte Vista St, Suite C, Ada, OK 74820-7220 | 2006-12-05 |
| 1326074113 | Audra K Cook | Family Medicine | 201 N Monte Vista St, Suite C, Ada, OK 74820-7213 | 2006-06-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578103727 | Curry Orthopedics and Sports Medicine Pllc | Orthopaedic Surgery | 919 Colony Drive, Ada, OK 74820 | 2020-01-15 |
| 1215574603 | Miranda Denise Bowman | Counselor | 1300 Hoppe Blvd., Suite 5, Ada, OK 74820 | 2019-12-04 |
| 1326509654 | Patricia June Harjo | Case Manager/Care Coordinator | Nittak Himitta' Women's and Children's Recovery Center, 2024 Te Ata Drive, Ada, OK 74820 | 2019-03-28 |
| 1649737172 | Rylee Nikole Leblanc | Case Manager/Care Coordinator | 1119 S High School St, Ada, OK 74820 | 2019-02-20 |
| 1891251328 | David Kinback | Rehabilitation Counselor | 1400 Hoppe Blvd., Suite 3, Cn Recovery Resource Services, Ada, OK 74820 | 2019-02-20 |
| 1922571009 | Central Oklahoma Family Medical Center, Inc. | Pharmacy | 905 Colony Dr, Ada, OK 74820 | 2019-01-10 |
| 1063988673 | Central Oklahoma Family Medical Center, Inc | Clinic/Center | 905 Colony Drive Bldg, Ada, OK 74820 | 2018-10-22 |
| 1265907885 | Apex Surgery Center, LLC | Surgery | 2001 Cradduck Road, Ada, OK 74820 | 2018-10-10 |
| 1689150898 | Sabrina Simmons | Social Worker | 2516 Oakhurst Dr Apt E, Ada, OK 74820 | 2018-07-11 |
| 1700370467 | Brianna Leigh Youngwolfe | Nurse Practitioner | 2020 Arlington St Ste 6, Ada, OK 74820 | 2018-06-17 |
| Find all providers in zip 74820 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356544951 | Kristin Diane Conkling | Pediatrics | 5125 E 107th Pl, Tulsa, OK 74137-7236 | 2007-06-09 |
| 1780789362 | Children & Adolescent Medical Services Inc. | Pediatrics | 8803 S. 101st E. Ave., Suite 200, Tulsa, OK 74133 | 2006-09-14 |
| 1770504037 | Miguel Antonio Camacho-garrido | Pediatrics | 1104 Walnut Dr, Ardmore, OK 73401-2353 | 2006-07-22 |
| 1497788624 | Shelley Ann Bohn | Pediatrics | 937 Sw 89th St, Suite A, Oklahoma City, OK 73139-9231 | 2006-07-09 |
| 1922038348 | Paul Andrew Scott Benson | Pediatrics | 4444 E. 41st Street, 2nd Floor, Ou Physicians -- Pediatrics, Tulsa, OK 74135 | 2006-07-03 |
| 1235128430 | Elizabeth Gail Lewis | Pediatrics | 2701 Sw Cornell Ave, Lawton, OK 73505-7121 | 2005-10-19 |
| 1578568010 | Julie Gail Sullivan | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2005-06-20 |
| 1902446917 | Chelsea Ryan Walker | Pediatrics | 12455 E 100th St N Ste 300, Owasso, OK 74055-4678 | 2020-01-08 |
| 1609005842 | Ahmad Pediatrics | Pediatrics | 302 E Downing St, Tahlequah, OK 74464-3014 | 2009-07-09 |
| 1235399122 | South Pointe Pediatrics, Pllc | Pediatrics | 1615 S Eucalyptus Ave, Suite 210, Broken Arrow, OK 74012-6159 | 2008-06-13 |
| 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.