Provider Demographics
NPI:1275596421
Name:DURANT FAMILY MEDICINE CLINIC, INC
Entity Type:Organization
Organization Name:DURANT FAMILY MEDICINE CLINIC, INC
Other - Org Name:DURANT FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-924-5500
Mailing Address - Street 1:1400 BRYAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2157
Mailing Address - Country:US
Mailing Address - Phone:580-924-5500
Mailing Address - Fax:580-924-1991
Practice Address - Street 1:1400 BRYAN DR STE 201
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2157
Practice Address - Country:US
Practice Address - Phone:580-924-5500
Practice Address - Fax:580-924-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100757080WMedicaid
OK100748440CMedicaid
OK100757080WMedicaid