BRENT WESLEY GALLOWAY JR MD PLLC (NPI# 1831451632) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831451632 |
| Entity Type | Organization |
| Organization Name | BRENT WESLEY GALLOWAY JR MD PLLC |
| Practice Address |
1701 E 6th St Okmulgee OK 74447-4807 |
| Mailing Address |
13423 S 19th St Bixby OK 74008-1009 |
| Practice Telephone | 9188918231 |
| Practice Fax Number | 9187565498 |
| Mailing Telephone | 9188918231 |
| Mailing Fax Number | 9187565498 |
| Enumeration Date | 2012-06-08 |
| Last Update Date | 2013-02-05 |
| Authorized Official Name | BRENT W GALLOWAY JR. (CEO) |
| Authorized Official Telephone | 9188918231 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
29413 | OK | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | OK MED LICENSE | 29413 | 01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oklahoma Business Registrations | BRENT WESLEY GALLOWAY JR MD PLLC | 1701 E 6th St, Okmulgee, OK 74447 |
| Street Address |
1701 E 6TH ST |
| City | OKMULGEE |
| State | OK |
| Zip Code | 74447-4807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144326489 | Rebold Manor L L C | Skilled Nursing Facility | 1701 E 6th St, Okmulgee, OK 74447-4807 | 2006-09-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932718376 | David Louis Holden | Counselor | 1803 W Wood Drive, Okmulgee, OK 74447 | 2020-07-30 |
| 1972097657 | Impact Rehab Consultants | Occupational Therapist | 114 West 7th Street, Okmulgee, OK 74447 | 2018-06-18 |
| 1992192504 | Taquia Bagby | Counselor | 1117 Martin L King Dr., Okmulgee, OK 74447 | 2015-04-21 |
| 1174935886 | Heather Houser | Case Manager/Care Coordinator | 1803 South Wood Drive, Okmuglee, OK 74447 | 2014-05-29 |
| 1376977066 | Anita Kaye Stallings | Case Manager/Care Coordinator | 1018 E 2nd St, Okmulgee, OK 74447 | 2013-08-29 |
| 1013283209 | Megan Breffney Wilson | Family Medicine | 112 West 5th Street, Okmulgee, OK 74447 | 2012-04-01 |
| 1245475466 | Mary Jones | Counselor | 323 W 6th Street, Okmulgee, OK 74447 | 2008-12-03 |
| 1881872182 | State of Oklahoma | Skilled Nursing Facility | 900 E. Airport Rd., Okmulgee, OK 74447 | 2008-02-08 |
| 1053539965 | Shannon Michelle Allison | Physical Therapist | 900 E. Airport Road, Okmulgee, OK 74447 | 2007-04-23 |
| 1023233772 | Ky Joel Kiger | Physical Therapist | 900 East Airport Road, Okmulgee, OK 74447 | 2007-04-16 |
| Find all providers in zip 74447 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1184222705 | Essential Md, Pllc | Clinic/Center | 6316 E 102nd St Ste 100, Tulsa, OK 74137-7061 | 2020-10-15 |
| 1881292191 | Team Clinic Management Partners LLC | Clinic/Center | 3100 W New Orleans St, Broken Arrow, OK 74011-1468 | 2020-10-09 |
| 1972115392 | Team Clinic Management Partners LLC | Clinic/Center | 225 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-18 |
| 1093327413 | Team Clinic Management Partners LLC | Clinic/Center | 301 W New Orleans St, Broken Arrow, OK 74011-2206 | 2020-08-18 |
| 1962013110 | Team Clinic Management Partners LLC | Clinic/Center | 4300 E Gary Street, Broken Arrow, OK 74014 | 2020-08-12 |
| 1750992038 | Team Clinic Management Partners LLC | Clinic/Center | 251 E Omaha St, Broken Arrow, OK 74012-1761 | 2020-08-11 |
| 1689285975 | Team Clinic Management Partners LLC | Clinic/Center | 301 E Tucson St, Broken Arrow, OK 74011-7235 | 2020-08-11 |
| 1417568700 | Team Clinic Management Partners LLC | Clinic/Center | 1351 E Albany St, Broken Arrow, OK 74012-8995 | 2020-08-11 |
| 1164033569 | Team Clinic Management Partners LLC | Clinic/Center | 6800 E Quincy Pl, Broken Arrow, OK 74014-4523 | 2020-08-11 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.