Provider Demographics
NPI:1699385278
Name:VERDIGRIS VALLEY FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:VERDIGRIS VALLEY FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:918-269-3693
Mailing Address - Street 1:25965 S HIGHWAY 66 STE B
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-2468
Mailing Address - Country:US
Mailing Address - Phone:918-269-3693
Mailing Address - Fax:
Practice Address - Street 1:25965 S HIGHWAY 66 STE B
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74019-2468
Practice Address - Country:US
Practice Address - Phone:918-550-0989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health