Provider Demographics
NPI:1922467505
Name:STOVER FAMILY CLINIC
Entity Type:Organization
Organization Name:STOVER FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, NP-C
Authorized Official - Phone:580-584-6600
Mailing Address - Street 1:813 VETERANS WAY
Mailing Address - Street 2:
Mailing Address - City:BROKEN BOW
Mailing Address - State:OK
Mailing Address - Zip Code:74728
Mailing Address - Country:US
Mailing Address - Phone:580-584-6600
Mailing Address - Fax:580-584-6603
Practice Address - Street 1:813 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:BROKEN BOW
Practice Address - State:OK
Practice Address - Zip Code:74728
Practice Address - Country:US
Practice Address - Phone:580-584-6600
Practice Address - Fax:580-584-6603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0096200261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service