Provider Demographics
NPI:1164722864
Name:FOUNDATION HEALTH & WELLNESS INSTITUTE PC
Entity Type:Organization
Organization Name:FOUNDATION HEALTH & WELLNESS INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:HIGGINS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-938-5179
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858-0610
Mailing Address - Country:US
Mailing Address - Phone:580-938-5400
Mailing Address - Fax:580-938-5409
Practice Address - Street 1:404 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858
Practice Address - Country:US
Practice Address - Phone:580-938-5400
Practice Address - Fax:580-938-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21839261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care