Provider Demographics
NPI:1851809677
Name:COHESIVE FAMILY PRACTICE
Entity Type:Organization
Organization Name:COHESIVE FAMILY PRACTICE
Other - Org Name:COHESIVE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEMIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:FEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-788-8155
Mailing Address - Street 1:2510 E INDEPENDENCE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 E INDEPENDENCE ST STE 102
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1839
Practice Address - Country:US
Practice Address - Phone:405-788-8155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COHESIVE HEALTHCARE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility