Provider Demographics
NPI:1528417409
Name:VALLEY FAMILY CLINIC INC
Entity Type:Organization
Organization Name:VALLEY FAMILY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-238-4633
Mailing Address - Street 1:106 BURR AVE
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-3848
Mailing Address - Country:US
Mailing Address - Phone:405-238-4633
Mailing Address - Fax:405-238-4690
Practice Address - Street 1:106 BURR AVE
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-3848
Practice Address - Country:US
Practice Address - Phone:405-238-4633
Practice Address - Fax:405-238-4690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1467593210OtherNPI
OK1730155904OtherNPI
OK200162480BMedicaid
OK100131280BMedicaid
OK1972531465OtherNPI
OK100124310AMedicaid
OK1730155904OtherNPI
OK1467593210OtherNPI
OKOKA102237Medicare PIN
OK405920ZNR2Medicare PIN