Provider Demographics
NPI:1407971492
Name:HUSSAINS FAMILY PRACTICE RHC
Entity Type:Organization
Organization Name:HUSSAINS FAMILY PRACTICE RHC
Other - Org Name:HUSSAINS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMER
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-465-5727
Mailing Address - Street 1:139 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-4229
Mailing Address - Country:US
Mailing Address - Phone:918-465-5727
Mailing Address - Fax:918-465-3311
Practice Address - Street 1:139 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-4229
Practice Address - Country:US
Practice Address - Phone:918-465-5727
Practice Address - Fax:918-465-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
OK89829363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1124093414OtherAHMER HUSSAIN M.D. NPI
OKSB1453OtherMEDICARE B
OK1407971492OtherNPI
OK1124093414OtherAHMER HUSSAIN M.D. NPI