Provider Demographics
NPI:1932237633
Name:VIC FEY MD INC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VIC FEY MD INC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-323-5433
Mailing Address - Street 1:90 N 30TH ST
Mailing Address - Street 2:#1
Mailing Address - City:CLINTON
Mailing Address - State:OK
Mailing Address - Zip Code:73601-3101
Mailing Address - Country:US
Mailing Address - Phone:580-323-5433
Mailing Address - Fax:580-323-3833
Practice Address - Street 1:90 N 30TH ST
Practice Address - Street 2:#1
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-3101
Practice Address - Country:US
Practice Address - Phone:580-323-5433
Practice Address - Fax:580-323-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100107020BMedicaid
OK100107020CMedicaid
OK100107020BMedicaid