Provider Demographics
NPI:1649991449
Name:FAMILY HEALTH CLINIC - CLINICAL DE SALUD FAMILIAR
Entity type:Organization
Organization Name:FAMILY HEALTH CLINIC - CLINICAL DE SALUD FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:405-371-0212
Mailing Address - Street 1:2329 NW 158TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9764
Mailing Address - Country:US
Mailing Address - Phone:405-371-0212
Mailing Address - Fax:
Practice Address - Street 1:1515 SE 44TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73129-7906
Practice Address - Country:US
Practice Address - Phone:405-371-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty