Provider Demographics
NPI:1912470949
Name:LAFAVE MELTON MEDICAL INC
Entity Type:Organization
Organization Name:LAFAVE MELTON MEDICAL INC
Other - Org Name:LAFAVE FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-399-3552
Mailing Address - Street 1:501 E CONWAY
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:OK
Mailing Address - Zip Code:74825-2904
Mailing Address - Country:US
Mailing Address - Phone:580-279-5169
Mailing Address - Fax:
Practice Address - Street 1:501 E CONWAY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:OK
Practice Address - Zip Code:74825-2904
Practice Address - Country:US
Practice Address - Phone:580-279-5169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-02
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty