Provider Demographics
NPI:1639618556
Name:DIMENSIONS FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:DIMENSIONS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:K
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:918-247-6000
Mailing Address - Street 1:18410 SLICK RD
Mailing Address - Street 2:
Mailing Address - City:KELLYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74039-4578
Mailing Address - Country:US
Mailing Address - Phone:918-247-6000
Mailing Address - Fax:
Practice Address - Street 1:13 N OAK
Practice Address - Street 2:
Practice Address - City:KELLYVILLE
Practice Address - State:OK
Practice Address - Zip Code:74039
Practice Address - Country:US
Practice Address - Phone:918-247-6000
Practice Address - Fax:918-247-2537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-13
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77550261Q00000X, 261QP2300X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200766750AMedicaid