Organization
GENESIS MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY LYNNE CLARK (BILLING/CREDENTIALING)
(580) 223-5180
Entity
Organization
Contact information
Practice address
2002 12TH AVE NW STE B, ARDMORE, OK 73401-1206
(580) 221-2022
(580) 221-2024
Mailing address
2002 12TH AVE NW STE B, ARDMORE, OK 73401-1206
(580) 221-2022
(580) 221-2024
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
Other
Enumeration date
08/10/2020
Last updated
02/26/2025
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