Provider Demographics
NPI:1972863041
Name:FGG LLC
Entity Type:Organization
Organization Name:FGG LLC
Other - Org Name:JENKINS STREET CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER, ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILICIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-701-2420
Mailing Address - Street 1:755 JENKINS AVE
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-4951
Mailing Address - Country:US
Mailing Address - Phone:405-701-2420
Mailing Address - Fax:405-701-2447
Practice Address - Street 1:755 JENKINS AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-4951
Practice Address - Country:US
Practice Address - Phone:405-701-2420
Practice Address - Fax:405-701-2447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-23
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service