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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