Provider Demographics
NPI:1265194807
Name:FAITH FAMILY CLINIC PLLC
Entity type:Organization
Organization Name:FAITH FAMILY CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-227-7448
Mailing Address - Street 1:4201 EVANDALE DR
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-7301
Mailing Address - Country:US
Mailing Address - Phone:580-227-7448
Mailing Address - Fax:
Practice Address - Street 1:4125 W OWEN K GARRIOTT RD STE A-1
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-4820
Practice Address - Country:US
Practice Address - Phone:580-616-3007
Practice Address - Fax:580-324-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty