Provider Demographics
NPI:1033129333
Name:PUTNAM NORTH FAMILY MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:PUTNAM NORTH FAMILY MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-722-9474
Mailing Address - Street 1:11220 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-2725
Mailing Address - Country:US
Mailing Address - Phone:405-722-9474
Mailing Address - Fax:405-722-9463
Practice Address - Street 1:11220 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-2725
Practice Address - Country:US
Practice Address - Phone:405-722-9474
Practice Address - Fax:405-722-9463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care