Provider Demographics
NPI:1841247368
Name:FIVE OAKS FAMILY CLINIC, INC.
Entity type:Organization
Organization Name:FIVE OAKS FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-574-1890
Mailing Address - Street 1:RR 3 BOX 458E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25840-9589
Mailing Address - Country:US
Mailing Address - Phone:304-574-1888
Mailing Address - Fax:304-574-1891
Practice Address - Street 1:RR 3 BOX 458E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:WV
Practice Address - Zip Code:25840-9589
Practice Address - Country:US
Practice Address - Phone:304-574-1888
Practice Address - Fax:304-574-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14161261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care