Provider Demographics
NPI:1578825147
Name:OGE FAMILY MEDICAL CLINIC PLLC
Entity Type:Organization
Organization Name:OGE FAMILY MEDICAL CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-451-9199
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0905
Mailing Address - Country:US
Mailing Address - Phone:870-451-9199
Mailing Address - Fax:
Practice Address - Street 1:119 MEDICAL CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8606
Practice Address - Country:US
Practice Address - Phone:870-451-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR318974Medicare PIN