Martiann Lee Bohl-Witchey, DO
Individual provider Active NPI Obstetrics & Gynecology Physician · Owasso, OK
NPI 1386652097 · NPPES record last updated Dec 20, 2017
Key facts
- NPI
- 1386652097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 4382 (OK)
- Practice address
- 12455 E 100TH St N Ste 220
Owasso, OK 74055-4675 - Phone
- (918) 274-5555
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061212000485 | OK | Practitioner - Obstetrics/Gynecology | 9830198209 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4382 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St. John Physicians, Inc | Current |
Accepting new patients | |
| St. John Physicians, Inc. | Obstetrics & Gynecology | Current |
Accepting new patients |
Locations
12455 E 100th St N
Ste 220
Owasso, OK 74055
Phone (918) 274-5555
1705 E 19th St
Ste 304
Tulsa, OK 74104
Phone (918) 748-7660
1705 E 19th St
Ste 302
Tulsa, OK 74104
Phone (918) 748-7585
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 4382 | OK | Yes |
Addresses
Primary practice location
12455 E 100TH St N Ste 220
Owasso, OK 74055-4675
Mailing address
12455 E 100TH St N Ste 220
Owasso, OK 74055-4675
Phone (918) 274-5555
Other providers in Owasso, OK
- Mariah Dalee Blunt I
- BMC Anesthesia PC
- Board of Regents of the University of Oklahoma Ou Physicians Tulsa
- Board of Regents of the University of Oklahoma Ou Physicians Tulsa
- Body Firm, Inc
- Barbara Roberts Bold
- Courtney Bolles
- Paula Ann Bonebrake
- Christel Borland
- Bounce Back Rehab, PLC
All providers in Owasso, OK · Obstetrics & Gynecology Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 20, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.