Provider Demographics
NPI:1164646436
Name:FAMILY MEDICAL CENTER & MINOR EMERGENCY, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER & MINOR EMERGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-369-2222
Mailing Address - Street 1:13330 S MEMORIAL DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3165
Mailing Address - Country:US
Mailing Address - Phone:918-369-2222
Mailing Address - Fax:
Practice Address - Street 1:13330 S MEMORIAL DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-3165
Practice Address - Country:US
Practice Address - Phone:918-369-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E26930Medicare UPIN