Provider Demographics
NPI:1902278286
Name:STUART FAMILY MEDICINE, PLLC.
Entity Type:Organization
Organization Name:STUART FAMILY MEDICINE, PLLC.
Other - Org Name:NEWMAN HEALTHCARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-938-5400
Mailing Address - Street 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHATTUCK
Mailing Address - State:OK
Mailing Address - Zip Code:73858-9205
Mailing Address - Country:US
Mailing Address - Phone:580-938-5400
Mailing Address - Fax:580-938-5409
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHATTUCK
Practice Address - State:OK
Practice Address - Zip Code:73858-9205
Practice Address - Country:US
Practice Address - Phone:580-938-5400
Practice Address - Fax:580-938-5409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK66926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty