Provider Demographics
NPI:1851736029
Name:GARVIN COUNTY OCCUPATIONAL & FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:GARVIN COUNTY OCCUPATIONAL & FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-665-2424
Mailing Address - Street 1:1202 E ROBERT S KERR BLVD
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:OK
Mailing Address - Zip Code:73098-2054
Mailing Address - Country:US
Mailing Address - Phone:405-665-2424
Mailing Address - Fax:
Practice Address - Street 1:1202 E ROBERT S KERR BLVD
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:OK
Practice Address - Zip Code:73098-2054
Practice Address - Country:US
Practice Address - Phone:405-665-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14651261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care