Provider Demographics
NPI:1487227617
Name:GIDEON FAMILY CARE LLC
Entity Type:Organization
Organization Name:GIDEON FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSBY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-708-4498
Mailing Address - Street 1:1601 SW 89TH ST STE D200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6383
Mailing Address - Country:US
Mailing Address - Phone:405-708-4498
Mailing Address - Fax:
Practice Address - Street 1:1601 SW 89TH ST STE D200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6383
Practice Address - Country:US
Practice Address - Phone:405-698-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-24
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care