Provider Demographics
NPI:1659581387
Name:FAMILY HEALTHCARE CLINIC, INC.
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-336-4822
Mailing Address - Street 1:1820 W HENSLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74003-2237
Mailing Address - Country:US
Mailing Address - Phone:918-336-4822
Mailing Address - Fax:918-336-5017
Practice Address - Street 1:1820 W HENSLEY BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74003-2237
Practice Address - Country:US
Practice Address - Phone:918-336-4822
Practice Address - Fax:918-336-5017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100202470AMedicaid
OK200064460AMedicaid