DAVENPORT MEDICAL CENTER LLC (NPI# 1992094049) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992094049 |
| Entity Type | Organization |
| Organization Name | DAVENPORT MEDICAL CENTER LLC |
| Practice Address |
203 N Broadway Davenport OK 74026 |
| Practice Telephone | 4052499611 |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2011-03-29 |
| Authorized Official Name | TRACY WOHLGEMUTH (MANAGER) |
| Authorized Official Telephone | 4052499611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
242 | OK | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144306036 | Davenport Medical Center LLC | Internal Medicine | 2502 Sand Mine Rd, Davenport, FL 33897-3402 | 2006-10-31 |
| Street Address |
203 N BROADWAY |
| City | DAVENPORT |
| State | OK |
| Zip Code | 74026 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932301900 | James Richard Lucas | General Practice | 202 Broadway Ave., Davenport, OK 74026 | 2007-06-01 |
| 1982660981 | Christina M. Jefferson | Internal Medicine | 202 Broadway, Davenport, OK 74026 | 2006-04-26 |
| 1093955643 | Town of Davenport | Ambulance | 214 Broadway, Davenport, OK 74026-0279 | 2009-02-23 |
| 1750570271 | Davenport Public Schools | Public Health or Welfare | 417 Broadway, Davenport, OK 74026-0849 | 2007-10-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669070777 | Carlie Shannon | Social Worker | 736 Federal St., Ste. 1-103, Davenport, IA 52803-5768 | 2020-10-12 |
| 1568069276 | Shannon Lea Wright | Pharmacist | 2021 Camden Loop, Davenport, FL 33837-1796 | 2020-10-06 |
| 1447857222 | Caren R Nituda | Nurse Practitioner | 1051 Andalusia Loop, Davenport, FL 33837-1443 | 2020-10-05 |
| 1447857123 | Omayra Rolon-rivera | Case Manager/Care Coordinator | 1371 Tuscana Ln Apt 6102, Davenport, FL 33896-5302 | 2020-10-05 |
| 1407463649 | Morrison Community Hospital District | Clinic/Center | 4622 Progress Dr Ste C, Davenport, IA 52807-3426 | 2020-09-30 |
| 1649887399 | Chelsea White | Nurse Practitioner | 225 Lake Davenport Blvd, Davenport, FL 33897-5425 | 2020-09-28 |
| 1679189971 | Amber Rae Rupiper | Physician Assistant | 518 Locus Street, Davenport, IA 52803 | 2020-09-22 |
| 1598371270 | Samantha Delores Gartner | Physician Assistant | 518 W Locust St # 287, Davenport, IA 52803-2829 | 2020-09-18 |
| 1497360796 | Ashlee Elizabeth Winter | Nurse Practitioner | 1132 Elderberry Dr, Davenport, FL 33897-3853 | 2020-09-14 |
| 1316552052 | Shannon Kathleen Christiansen | Chiropractor | 2108 Vine St, Davenport, IA 52804-2056 | 2020-09-10 |
| Find all providers in DAVENPORT | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558869321 | Devan Louis Depauw | Physician Assistant | 1227 East Rusholme St., Davenport, IA 52803 | 2018-01-26 |
| 1861008443 | Justyna Wojtyczka | Physician Assistant | 518 W Locust St, Davenport, IA 52803-2829 | 2020-09-19 |
| 1962891499 | Kristian Delanie Williams | Physician Assistant | 40124 Highway 27, Suite 104, Davenport, FL 33837-5905 | 2015-01-21 |
| 1457696080 | Karyl Hobbs | Physician Assistant | 2502 Sand Mine Rd, Davenport, FL 33897-3402 | 2012-12-07 |
| 1699913061 | Nicole Marie Luszczyk | Physician Assistant | 2322 E Kimberly Rd, Ste 100n, Davenport, IA 52807-7205 | 2009-01-23 |
| 1790742864 | Jeremy J Mcgrath | Physician Assistant | 3385 Dexter Ct, Ste 101, Davenport, IA 52807-3471 | 2006-05-01 |
| 1477528073 | Paulette Ong | Physician Assistant | 1801 E 54th St, Ste 100, Davenport, IA 52807-7209 | 2006-02-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790392868 | James Scott Turner | Physician Assistant | 924 Nw 14th St, Moore, OK 73160-1610 | 2020-09-23 |
| 1386283679 | Cody Rice Chambers | Physician Assistant | 2002 12th Ave Nw Ste B, Ardmore, OK 73401-1206 | 2020-01-03 |
| 1073154647 | Haley Nicole Beaird | Physician Assistant | 8907 E 93rd St, Tulsa, OK 74133-5634 | 2019-10-03 |
| 1568920924 | Direct2u Urgent Care Pllc | Physician Assistant | 2417 County Road 1263, Blanchard, OK 73010-3123 | 2019-03-05 |
| 1538625660 | Symachia LLC | Physician Assistant | 115 N. Main St., Cashion, OK 73106 | 2019-02-13 |
| 1982172029 | William Landon Ross | Physician Assistant | 3705 W Memorial Rd Ste 101, Oklahoma City, OK 73134-1508 | 2018-11-07 |
| 1639646656 | Jacob Allbritton | Physician Assistant | 10824 Admiral Dr, Oklahoma City, OK 73162-6843 | 2018-10-29 |
| 1316420086 | Lauren Anto | Physician Assistant | 2824 Classen Blvd Ste 100, Norman, OK 73071-4059 | 2018-09-10 |
| 1073004768 | Shelby Teel | Physician Assistant | 1200 Everett Dr # 8305, Oklahoma City, OK 73104-5047 | 2018-05-29 |
| 1093240749 | Green's Country Clinic, LLC | Physician Assistant | 223 E Blackwell Ave, Blackwell, OK 74631-2909 | 2017-05-01 |
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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.