Provider Demographics
NPI:1598981920
Name:RANCH ACRES FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:RANCH ACRES FAMILY PRACTICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:TROUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-747-0900
Mailing Address - Street 1:3233 E 31ST ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2454
Mailing Address - Country:US
Mailing Address - Phone:918-747-0900
Mailing Address - Fax:918-747-0980
Practice Address - Street 1:3233 E 31ST ST
Practice Address - Street 2:SUITE 104
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2454
Practice Address - Country:US
Practice Address - Phone:918-747-0900
Practice Address - Fax:918-747-0980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty