Matthew H Moore (NPI# 1700053394, PAC ID# 6901972561) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1700053394 |
| PAC ID by PECOS | 6901972561 |
| Professional Enrollment ID | I20100329000058 |
| Full Name | Matthew H Moore |
| Organization Legal Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Address |
405 E Excelsior Ave Vinita OK 74301-4226 |
| Phone Number | 9182566476 |
| Gender | M |
| Graduation Year | 2007 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 4688711534 |
| Number of Group Practice Members | 14 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 138 S Main, Afton, OK 74331-1822 | 9182574244 | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| 1115 Harbor Rd, Grove, OK 74344-3505 | 9187864434 | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| 111 S Treaty Rd, Miami, OK 74354-5327 | 9185401511 | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| 405 E Excelsior Ave, Vinita, OK 74301-4226 | 9182566476 | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Organization Legal Name | GRAND LAKE MENTAL HEALTH CENTER, INC. |
| Physicians | 28 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Allie Beth Craig | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 604 S Walnut St, Stillwater, OK 74074-4222 |
| Phyllis A Emery | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 700 Sw Penn Ave, Bartlesville, OK 74003-4331 |
| Mania Hill-u | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 109 N Fairland St, Pryor, OK 74361-4203 |
| Brent J Brewer | Physician Assistant | Grand Lake Mental Health Center, Inc. | 111 S Treaty Rd, Miami, OK 74354-5327 |
| Shannon Antoinette Rowland | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 231 E Graham Ave, Pryor, OK 74361-2436 |
| Stephanie Heaton | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 1115 Harbor Rd, Grove, OK 74344-3505 |
| Greg Salzer | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 405 E Excelsior Ave, Vinita, OK 74301-4226 |
| Amy Dawn Humphrey | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 138 S Main, Afton, OK 74331-1822 |
| Julie D Finney | Physician Assistant | Grand Lake Mental Health Center, Inc. | 12005 E 470 Rd, Claremore, OK 74017-3737 |
| Weldon J Mallgren | Psychiatry | Grand Lake Mental Health Center, Inc. | 17599 S Hwy 88, Claremore, OK 74017-0801 |
| Street Address |
405 E EXCELSIOR AVE |
| City | VINITA |
| State | OK |
| Zip | 74301-4226 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Greg Salzer | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 405 E Excelsior Ave, Vinita, OK 74301-4226 |
| Julie Burnshire | Clinical Social Worker | Grand Lake Mental Health Center, Inc. | 405 E Excelsior Ave, Vinita, OK 74301-4226 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jodee Sue Carrier | Nurse Practitioner | Dr.mickey Tyrrell, M.d. Pllc | 803 N Foreman, Suite 102, Vinita, OK 74301-1412 |
| Mickey R Tyrrell | Family Medicine | Dr.mickey Tyrrell, M.d. Pllc | 803 N Foreman, Suite 102, Vinita, OK 74301-1412 |
| William A Rogers | Physician Assistant | Saint Francis Hospital Vinita, Inc. | 735 N Foreman St, Vinita, OK 74301-1422 |
| Shiela D Williams | Nurse Practitioner | Warren Clinic Inc | 715 N Foreman St, Vinita, OK 74301-1422 |
| Laura Hallacy | Nurse Practitioner | Saint Francis Hospital Vinita, Inc. | 735 N Foreman St, Vinita, OK 74301-1422 |
| Tracy L Parker | Nurse Practitioner | Saint Francis Hospital Vinita, Inc. | 735 N Foreman St, Vinita, OK 74301-1422 |
| Teresa K Deckard | Occupational Therapy | Saint Francis Hospital Vinita, Inc. | 711 N Brewer St, Vinita, OK 74301-1426 |
| Joseph Clark | Chiropractic | 803 N Foreman St, Vinita, OK 74301-1435 | |
| Alyssa D Bailey | Physical Therapy | Saint Francis Hospital Vinita, Inc. | 715 N Brewer St, Vinita, OK 74301-1439 |
| Chad L Diebold | Occupational Therapy | Saint Francis Hospital Vinita, Inc. | 715 N Brewer St, Vinita, OK 74301-1439 |
| Find all physicians in zip 74301 | |||
| City | VINITA |
| Zip Code | 74301 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | VINITA + PHYSICIAN ASSISTANT |
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| 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.