Provider Demographics
NPI:1639310907
Name:REBECCA BIORATO INC
Entity Type:Organization
Organization Name:REBECCA BIORATO INC
Other - Org Name:FAMILY MEDICAL CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIORATO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-818-7425
Mailing Address - Street 1:14936 SW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-9599
Mailing Address - Country:US
Mailing Address - Phone:405-256-5011
Mailing Address - Fax:405-324-5074
Practice Address - Street 1:731 E STATE HIGHWAY 152
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064
Practice Address - Country:US
Practice Address - Phone:405-256-5011
Practice Address - Fax:405-256-5074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200036540BMedicaid
OK200237450AMedicaid
OK200237450AMedicaid