Ada Gynecology & Obstetrics

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

8279 Issued in OK

Legal business name

ADA GYNECOLOGY & OBSTETRICS

Practice address

1414 Arlington St Ste 1700
Ada, OK 74820-2694

Phone

(580) 436-9088

Fax

(580) 436-0035

NPI assigned

Apr 9, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jimmy B Wallace, M.D.

Title

Owner

Phone

(580) 436-9088

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Phyllis A Wallace, APRN

  • Family Nurse Practitioner
  • Konawa, OK
  • NPI 1366486417
  NPD (past)

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1881717544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON ST STE 1700",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202694",
            "telephone_number": "580-436-9088",
            "fax_number": "580-436-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 ARLINGTON ST STE 1700",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748202694",
            "telephone_number": "580-436-9088",
            "fax_number": "580-436-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADA GYNECOLOGY & OBSTETRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "JIMMY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "580-436-9088",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OK",
            "license": "8279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ada Dentistry and Braces (Ada Dentistry)
• Ada Family Chiropractic P.L.L.C.
• Ada Family Dentistry Inc.
• Ada Family Eye Care Inc
• Ada Family Medical Center, PLLC
• Ada Health First Inc
• Ada Medical Group PLLC
• Ada Medical Inc (Ada Physical Therapy)
• Ada Men's Clinic LLC (Ada Family Wellness Clinic)
• Ada MRI Associates, L.L.C. (Ada Open MRI)

• Preferred Provider Organization in Ada, OK
• Providers in Ada, OK by specialty
• Preferred Provider Organization in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.