Max Edward Owen, PA
Individual provider Active NPI Physician Assistant · Henryetta, OK
NPI 1811904071 · NPPES record last updated Mar 19, 2013
Key facts
- NPI
- 1811904071
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 1540 (OK)
- Practice address
- 2405 West Main
Henryetta, OK 74437-3893 - Phone
- (918) 650-1180
- Fax
- (918) 650-1294
- NPI assigned
- Aug 1, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4535 Dressler Rd NW
Canton, OH 44718-2545
836 W 84TH St
Tulsa, OK 74132-3204
Hospital & facility affiliations
- Ascension St John Jane Phillips
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OK, NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070206000569 | OK | Practitioner - Physician Assistant | 5698777522 | Reassigns benefits to 3 organizations |
| I20251118003436 | NC | Practitioner - Physician Assistant | 5698777522 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1540 | OK | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Warren Clinic Inc | Current |
Accepting new patients | |
| Green Country Emergency Physicians Group of Tulsa PLLC | Current |
Accepting new patients | |
| Emergency Medicine Physicians of Carteret County, PLLC | Current |
Accepting new patients | |
| Emergency Medicine Physicians of Craven County, PLLC | Current |
Accepting new patients | |
| Ahs Oklahoma Physician Group LLC | Physician Assistant | Past | Accepting new patients |
Locations
3500 Arendell St
Morehead City, NC 28557
Phone (252) 499-6000
2000 Neuse Blvd
New Bern, NC 28560
Phone (252) 633-8104
300 Rockefeller Dr
Muskogee, OK 74401
Phone (918) 682-5501
10501 E 91st St
Tulsa, OK 74133
Phone (918) 307-6000
6600 S Yale Ave
Ste 1400
Tulsa, OK 74136
Phone (888) 247-0125
1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090
Interoperability endpoints
- https://epicproxy.ardenthealth.com/fhir/UPC/api/FHIR/R4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1540 | OK | Yes |
Addresses
Primary practice location
2405 West Main
Henryetta, OK 74437-3893
Mailing address
2405 W Main St
Henryetta, OK 74437-3893
Phone (918) 650-1180
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1540 | Other | OK | PHYSICIAN ASSISTANTS |
Other providers in Henryetta, OK
- Lori D Mulliniks
- Sarah Elizabeth Mulliniks
- New Hope Home Health Nursing,LLC
- Okemah Pharmacy Inc.
- Oklahoma Em-1 Medical Services, P.C.
- Wesley E Parkhurst Jr.
- Path and Purpose Counseling, PLLC.
- Peak Medical Oklahoma No. 12, Inc.
- Garrett Pearson
- Crystal Dawn Pelley
All providers in Henryetta, OK · Physician Assistant in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 19, 2013. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.