Provider Demographics
NPI:1558343640
Name:TRICITY FAMILY PHYSICIANS, PC
Entity Type:Organization
Organization Name:TRICITY FAMILY PHYSICIANS, PC
Other - Org Name:TRICITY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-387-4546
Mailing Address - Street 1:PO BOX 892398
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73189-2398
Mailing Address - Country:US
Mailing Address - Phone:405-387-4546
Mailing Address - Fax:405-321-8081
Practice Address - Street 1:300 BY PASS RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-6392
Practice Address - Country:US
Practice Address - Phone:405-387-4546
Practice Address - Fax:405-321-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK17440261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100748470AMedicaid