Provider Demographics
NPI:1629226717
Name:FAMILY MEDICAL OFFICE, LLC
Entity Type:Organization
Organization Name:FAMILY MEDICAL OFFICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:SAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-691-2838
Mailing Address - Street 1:9220 S PENN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6937
Mailing Address - Country:US
Mailing Address - Phone:405-691-2838
Mailing Address - Fax:405-692-8807
Practice Address - Street 1:9220 S PENN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6937
Practice Address - Country:US
Practice Address - Phone:405-691-2838
Practice Address - Fax:405-692-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19400208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty