Theron Joseph Bliss (NPI# 1538364245, PAC ID# 0446420459) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is FAMILY MEDICINE.
| Nation Provider ID (NPI) | 1538364245 |
| PAC ID by PECOS | 0446420459 |
| Professional Enrollment ID | I20110831000235 |
| Full Name | Theron Joseph Bliss |
| Organization Legal Name | OMNI MEDICAL GROUP INC |
| Address |
800 W Boise Cir Suite 160 Broken Arrow OK 74012-4932 |
| Phone Number | 9189949160 |
| Gender | M |
| Medical School | OKLAHOMA COLLEGE OF OSTEOPATHIC MEDICINE AND SURGERY |
| Graduation Year | 2007 |
| Primary Specialty | FAMILY MEDICINE |
| Group Practice PAC ID | 9739080490 |
| Number of Group Practice Members | 91 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 370114 | ST JOHN MEDICAL CENTER, INC |
| 371312 | ST JOHN SAPULPA, INC |
| 370235 | ST JOHN BROKEN ARROW, INC |
| Address | Phone | Organization |
|---|---|---|
| 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 | 9189949160 | OMNI MEDICAL GROUP INC |
| 1923 S Utica Ave, Tulsa, OK 74104-6520 | 9187442967 | OMNI MEDICAL GROUP INC |
| 8115 S Memorial Dr, Tulsa, OK 74133-4331 | 9182546315 | OMNI MEDICAL GROUP INC |
| Organization Legal Name | OMNI MEDICAL GROUP INC |
| Physicians | 96 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Goldameir Akingbola | Family Medicine | Omni Medical Group Inc | 1021 E Bryan Ave, Sapulpa, OK 74066-4512 |
| Mitzi Blanchard | Nurse Practitioner | Omni Medical Group Inc | 1421 E 13th St, Tulsa, OK 74120-5207 |
| Kelly R Wratten | Nurse Practitioner | Omni Medical Group Inc | 8115 S Memorial Dr, Tulsa, OK 74133-4331 |
| Ana Trujillo | Nurse Practitioner | Omni Medical Group Inc | 4720 S Harvard Ave, Suite 100, Tulsa, OK 74135-3023 |
| Michael H Vu | Family Medicine | Omni Medical Group Inc | 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 |
| Brian T Crotty | Family Medicine | Omni Medical Group Inc | 1923 S Utica Ave, Tulsa, OK 74104-6520 |
| David L Smith | Family Medicine | Omni Medical Group Inc | 13600 E 86th St N, Suite 100, Owasso, OK 74055-8732 |
| Michelle Green | Physician Assistant | Omni Medical Group Inc | 1923 S Utica Ave, Tulsa, OK 74104-6520 |
| Monica A Lee | Physician Assistant | Omni Medical Group Inc | 1923 S Utica Ave, Tulsa, OK 74104-6520 |
| Patricia Duffy-feins | Clinical Social Worker | Omni Medical Group Inc | 1923 S Utica Ave, Tulsa, OK 74104-6520 |
| Street Address |
800 W BOISE CIR SUITE 160 |
| City | BROKEN ARROW |
| State | OK |
| Zip | 74012-4932 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael H Vu | Family Medicine | Omni Medical Group Inc | 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 |
| Rachel M. Wilkinson | Nurse Practitioner | Tulsa Urology Plc | 800 W Boise Cir, Suite 210, Broken Arrow, OK 74012-4932 |
| Shelley Lynn Hogue | Podiatry | Restoration Foot and Ankle Pllc | 800 W Boise Cir, Suite 150, Broken Arrow, OK 74012-4932 |
| Jennifer Vanderford | Nurse Practitioner | Omni Medical Group Inc | 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 |
| Corinne Parkins | Physician Assistant | Omni Medical Group Inc | 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 |
| Bradley D Beasley | Podiatry | Restoration Foot and Ankle Pllc | 800 W Boise Cir, Suite 150, Broken Arrow, OK 74012-4932 |
| Richard Baker Saint | Urology | Tulsa Urology Plc | 800 W Boise Cir, Suite 210, Broken Arrow, OK 74012-4932 |
| Robert G Niebergall | Internal Medicine | Omni Medical Group Inc | 800 W Boise Cir, Suite 160, Broken Arrow, OK 74012-4932 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Scott M Hibbets | Optometry | 433 Stone Wood Dr, Broken Arrow, OK 74012-1026 | |
| Brad F Wells | Optometry | 433 Stone Wood Dr, Broken Arrow, OK 74012-1026 | |
| Travis D Ring | Chiropractic | 2433 N Aspen Ave, Broken Arrow, OK 74012-1142 | |
| Marilyn Sue Taylor | Physician Assistant | Pmo Medical Pllc | 1751 N Aspen Ave, Broken Arrow, OK 74012-1197 |
| Jeffrey L Halford | Physical Medicine and Rehabilitation | Pmo Medical Pllc | 1751 N Aspen Ave, Broken Arrow, OK 74012-1197 |
| Jo-anna Coppin Lohr | Nurse Practitioner | Pmo Medical Pllc | 1751 N Aspen Ave, Broken Arrow, OK 74012-1197 |
| Brent W Henderson | Anesthesiology | Pmo Medical Pllc | 1751 N Aspen Ave, Broken Arrow, OK 74012-1197 |
| Dena Marie Brunk | Physical Therapy | Redbud Physical Therapy LLC | 1700 W Albany St, Suite 310, Broken Arrow, OK 74012-1478 |
| Amira A Al Jiboori | Physical Therapy | Redbud Physical Rehabilitation PC | 1700 W Albany, Suite 310, Broken Arrow, OK 74012-1478 |
| Emily Lynne Sweeney | Physical Therapy | Redbud Physical Therapy LLC | 1700 W Albany St, Suite 310, Broken Arrow, OK 74012-1478 |
| Find all physicians in zip 74012 | |||
| City | BROKEN ARROW |
| Zip Code | 74012 |
| Specialty | FAMILY MEDICINE |
| City + Specialty | BROKEN ARROW + FAMILY MEDICINE |
Please comment or provide details below to improve the information on Theron Joseph Bliss.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.