Provider Demographics
NPI:1902950116
Name:DAVID W FURR LLC
Entity Type:Organization
Organization Name:DAVID W FURR LLC
Other - Org Name:ROLAND AVAILABLE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FURR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-420-6618
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1555
Mailing Address - Country:US
Mailing Address - Phone:918-427-3760
Mailing Address - Fax:918-427-0081
Practice Address - Street 1:307 E RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954-5160
Practice Address - Country:US
Practice Address - Phone:918-427-3760
Practice Address - Fax:918-427-0081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3855207R00000X
ARE-3777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100072520-CMedicaid
AR9R067OtherBLUE CROSS BLUE SHIELD AR
AR150957003Medicaid
ARH67673Medicare UPIN
AR9R067OtherBLUE CROSS BLUE SHIELD AR