Spectra Medical Home Mht LLC

NPI #1700201498 in Choctaw, Oklahoma

Provider Information

NPI Number: 1700201498
Entity Type: Organization
Organization Name: Spectra Medical Home Mht LLC
Primary Specialty: Physician Assistant
Enumeration Date: Mar 4, 2014
Last Updated: Mar 4, 2014

Practice Location

Address: 12500 NE 36TH ST
City: Choctaw
State: Oklahoma
ZIP Code: 73020-9111
Phone: (855) 860-2109

Authorized Official

Name: ELMER GARI OWENS
Title: OWNER
Phone: (855) 860-2109

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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