Provider Demographics
NPI:1598954117
Name:RANAS FAMILY MEDICAL CLINIC P C
Entity Type:Organization
Organization Name:RANAS FAMILY MEDICAL CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:918-465-0170
Mailing Address - Street 1:810 HIGHWAY 2 N
Mailing Address - Street 2:
Mailing Address - City:WILBURTON
Mailing Address - State:OK
Mailing Address - Zip Code:74578-3625
Mailing Address - Country:US
Mailing Address - Phone:918-465-0170
Mailing Address - Fax:918-465-4830
Practice Address - Street 1:810 HIGHWAY 2 N
Practice Address - Street 2:
Practice Address - City:WILBURTON
Practice Address - State:OK
Practice Address - Zip Code:74578-3625
Practice Address - Country:US
Practice Address - Phone:918-465-0170
Practice Address - Fax:918-465-4830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK900522360Medicare PIN