Provider Demographics
NPI:1710311154
Name:ACADIA FAMILY MEDICAL CLINIC L.L.C.
Entity Type:Organization
Organization Name:ACADIA FAMILY MEDICAL CLINIC L.L.C.
Other - Org Name:ACADIA FAMILY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLOWERETTE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP, NP-C
Authorized Official - Phone:918-287-9112
Mailing Address - Street 1:230 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PAWHUSKA
Mailing Address - State:OK
Mailing Address - Zip Code:74056-5204
Mailing Address - Country:US
Mailing Address - Phone:918-287-9112
Mailing Address - Fax:918-287-9113
Practice Address - Street 1:230 E 5TH ST
Practice Address - Street 2:
Practice Address - City:PAWHUSKA
Practice Address - State:OK
Practice Address - Zip Code:74056-5204
Practice Address - Country:US
Practice Address - Phone:918-287-9112
Practice Address - Fax:918-287-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27629207Q00000X, 208VP0000X
OK3512416926261QP2300X
OK70154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty