# GENESIS MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Oklahoma Bone & Joint P C, Genesis Medical PLLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285434233
- **Authorized official:** SHERRY LYNNE CLARK (BILLING/CREDENTIALING)
- **Authorized official phone:** (580) 223-5180

## Contact information

- **Practice address:** 2002 12TH AVE NW STE B, ARDMORE, OK 73401-1206
- **Practice address phone:** (580) 221-2022
- **Mailing address:** 2002 12TH AVE NW STE B, ARDMORE, OK 73401-1206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2025
- **Last updated:** 03/24/2025