ANDERSON FAMILY MEDICAL CLINIC LLC NPI 1790398360

NPI Information

NPI: 1790398360
Provider Name: ANDERSON FAMILY MEDICAL CLINIC, LLC
Classification: Clinic/Center - 261QH0100X
Entity Type: Organization

Specialization: Health Service

CLIA Number: 37D2188807

Address:
2505 N BROADWAY ST
POTEAU, OK
ZIP 74953
Phone: (918) 564-2726
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ANDERSON FAMILY MEDICAL CLINIC, LLC is a health service clinic center in Poteau, OK. ANDERSON FAMILY MEDICAL CLINIC, LLC NPI is 1790398360. The provider is registered as an organization entity type.

The provider's business location address is:

2505 N BROADWAY ST
POTEAU, OK
ZIP 74953-050
Phone: (918) 564-2726
Fax: (918) 564-2732

The provider's authorized official is Shelly Dawn Anderson .
The authorized official title is Aprn and has the following contact phone number (918) 564-2726.

The CLIA number assigned to this NPI record is 37D2188807 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2020 and was last updated on 7/17/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QH0100X	Clinic/Center	Health Service			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200571200A	MEDICAID	OKLAHOMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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