Spectra Medical Home MHT LLC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA619 Issued in OK

Legal business name

SPECTRA MEDICAL HOME MHT LLC

Practice address

12500 NE 36TH St
Choctaw, OK 73020-9111

Phone

(855) 860-2109

NPI assigned

Mar 4, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Elmer Gari Owens

Title

Owner

Phone

(855) 860-2109

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1700201498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 HERITAGE DRIVE",
            "address_2": "SUITE 110",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750693379",
            "telephone_number": "972-616-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 NE 36TH ST",
            "city": "CHOCTAW",
            "state": "OK",
            "postal_code": "730209111",
            "telephone_number": "855-860-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRA MEDICAL HOME MHT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "OWENS",
        "authorized_official_first_name": "ELMER",
        "authorized_official_middle_name": "GARI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "855-860-2109"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "PA619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Choctaw, OK
• Providers in Choctaw, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.