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Organization
TONKAWA HEALTHCARE SYSTEMS PC
Active
Organization
TONKAWA HEALTHCARE SYSTEMS PC
Active
Other names
TONKAWA MEDICAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIE JESSE STREET PA (PRESIDENT)
(580) 628-4800
Entity
Organization
Contact information
Practice address
600 E GRAND AVE, TONKAWA, OK 74653-3545
(580) 628-4800
(580) 628-3655
Mailing address
PO BOX 532, TONKAWA, OK 74653-0532
(580) 628-4800
(580) 628-3655
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
631
OK
Other
Enumeration date
03/13/2007
Last updated
08/22/2020
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