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Grand Lake Medical and Wellness Corp — NPI 1336706118, Sallisaw, OK | NPI Central

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NPI 1336706118

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Grand Lake Medical and Wellness Corp

NPI 1336706118 · Pain Clinic/Center · Sallisaw, OK

Provider details

NPI number: 1336706118
Entity type: Organization
Primary specialty: Pain Clinic/CenterAmbulatory Health Care Facilities
Organization subpart: No
Authorized official: Serena Wilson, Owner(918) 961-1658

Specialties & taxonomies

Pain Clinic/CenterPrimary261QP3300X
Ambulatory Health Care Facilities
Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities

Practice location

101 W Quesenbury Ave

Sallisaw, OK 74955-3613

Phone: (918) 235-6877

Approximate (ZIP-level) locationGet directions

More OK providers

Mailing address

58700 E 190 Rd

Fairland, OK 74343-2500

Other names (DBA / former)

Doing business as: Serena Wilson

Additional practice locations (1)

302 N Greenwood Ave
Fort Smith, AR 72901-3454
Phone: (479) 434-3600

Registry dates

Enumerated: 2019-05-28
Last updated: 2019-05-28

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.