Provider Demographics
NPI:1083809479
Name:GERBER FAMILY LLC
Entity Type:Organization
Organization Name:GERBER FAMILY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTERHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-263-4666
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:OKARCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73762-0129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 W KANSAS
Practice Address - Street 2:
Practice Address - City:OKARCHE
Practice Address - State:OK
Practice Address - Zip Code:73762
Practice Address - Country:US
Practice Address - Phone:405-263-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11794207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========001OtherBLUE CROSS BLUE SHIELD
D34682Medicare UPIN