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Organization

FIRST CHOICE WELLNESS CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ADDIE BETH GRATZ ARNP (OWNER)
(580) 371-0500
Entity
Organization

Contact information

Practice address
9 N MAIN, KINGSTON, OK 73439-7343
(158) 056-4050
(580) 564-0500
Mailing address
PO BOX 849, TISHOMINGO, OK 73460-0849
(580) 564-0500
(580) 564-0250

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
7588
OK
364SF0001X
Family Health Clinical Nurse Specialist
R0067529
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200117140A
OK
Enumeration date
07/26/2007
Last updated
03/17/2018
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