Provider Demographics
NPI:1598475733
Name:FAMILY MATTERS MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:FAMILY MATTERS MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:WHITEBIRD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-276-3553
Mailing Address - Street 1:114 S DEAN A MCGEE AVE
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-7822
Mailing Address - Country:US
Mailing Address - Phone:405-276-3553
Mailing Address - Fax:
Practice Address - Street 1:114 S DEAN A MCGEE AVE
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-7822
Practice Address - Country:US
Practice Address - Phone:405-276-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care