Provider Demographics
NPI:1467168096
Name:FORSTER DPC LLC
Entity Type:Organization
Organization Name:FORSTER DPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FORSTER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:580-563-0454
Mailing Address - Street 1:3000 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1349
Mailing Address - Country:US
Mailing Address - Phone:580-563-0454
Mailing Address - Fax:580-603-8602
Practice Address - Street 1:3000 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1349
Practice Address - Country:US
Practice Address - Phone:580-563-0454
Practice Address - Fax:580-603-8602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty