Provider Demographics
NPI:1609540731
Name:QUICKCARE FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:QUICKCARE FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-915-0045
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74343-0570
Mailing Address - Country:US
Mailing Address - Phone:918-915-0045
Mailing Address - Fax:
Practice Address - Street 1:209 WEST CONNER
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRLAND
Practice Address - State:OK
Practice Address - Zip Code:74343
Practice Address - Country:US
Practice Address - Phone:918-915-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty