# SPECTRA MEDICAL HOME MHT LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700201498
- **Authorized official:** ELMER GARI OWENS (OWNER)
- **Authorized official phone:** (855) 860-2109

## Contact information

- **Practice address:** 12500 NE 36TH ST, CHOCTAW, OK 73020-9111
- **Practice address phone:** (855) 860-2109
- **Mailing address:** 1515 HERITAGE DRIVE, SUITE 110, MCKINNEY, TX 75069-3379
- **Mailing address phone:** (972) 616-4702

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA619 | OK | Yes |

## Other

- **Enumeration date:** 03/04/2014
- **Last updated:** 03/04/2014