Provider Demographics
NPI:1407899941
Name:ARBUCKLE FAMILY CLINIC
Entity Type:Organization
Organization Name:ARBUCKLE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-622-2161
Mailing Address - Street 1:2011 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4221
Mailing Address - Country:US
Mailing Address - Phone:580-622-2161
Mailing Address - Fax:580-622-5519
Practice Address - Street 1:2011 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4221
Practice Address - Country:US
Practice Address - Phone:580-622-2161
Practice Address - Fax:580-622-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371328Medicare ID - Type Unspecified