1265627087 NPI number — FAMILY CARE OF WOODWARD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265627087 NPI number — FAMILY CARE OF WOODWARD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY CARE OF WOODWARD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265627087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
WOODWARD
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73801-3021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-256-2900
Provider Business Mailing Address Fax Number:
580-256-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
WOODWARD
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73801-3021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-256-2900
Provider Business Practice Location Address Fax Number:
580-256-3900
Provider Enumeration Date:
09/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERDECIA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
580-256-2900

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  25220 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com