Provider Demographics
NPI:1710184882
Name:PAYNE COUNTY FAMILY PRACTICE, INC.
Entity Type:Organization
Organization Name:PAYNE COUNTY FAMILY PRACTICE, INC.
Other - Org Name:DIVORCE VISITATION ARBITRATION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-377-3766
Mailing Address - Street 1:2216 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5127
Mailing Address - Country:US
Mailing Address - Phone:405-377-3766
Mailing Address - Fax:405-377-3768
Practice Address - Street 1:2216 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5127
Practice Address - Country:US
Practice Address - Phone:405-377-3766
Practice Address - Fax:405-377-3768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management