F.G.M.A. LLC. NPI 1922136480

NPI Information

  • NPI: 1922136480
  • Provider Name: F.G.M.A. ,LLC.
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • Other Name: FAMILY AND GERIATRIC MEDICAL ASSOCIATES
  • CLIA Number: 37D0471171
  • Address: 5622 N PORTLAND AVE
    #102
    OKLAHOMA CITY, OK
    ZIP 73112
  • Phone: (405) 917-7590

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NPI Details

F.G.M.A. ,LLC. is a family nurse practitioner in Oklahoma City, OK. F.G.M.A. ,LLC. NPI is 1922136480. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Other Name Is Family And Geriatric Medical Associates.

The provider's business location address is:

5622 N PORTLAND AVE
#102
OKLAHOMA CITY, OK
ZIP 73112-096
Phone: (405) 917-7590
Fax: (405) 917-7595

The provider's authorized official is Susan B Grandle .
The authorized official title is Nurse Practitioner and has the following contact phone number (405) 917-7590.

The CLIA number assigned to this NPI record is 37D0471171 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 2/28/2007 and was last updated on 6/4/2015.

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
1363LF0000XNurse PractitionerFamilyR0028064OKLAHOMAYes

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
1R0028064OTHEROKLAHOMASUSAN GRANDLE LIC #
2100216830DMEDICAIDOKLAHOMA
3300522043MEDICARE ID-TYPE UNSPECIFIEDOKLAHOMAGROUP NUMBER
4P02494MEDICARE UPINOKLAHOMA

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: 11/21/2025

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