Provider Demographics
NPI:1548355134
Name:FAMILY HEALTH CARE & MINOR EMERGENCY CLINIC INC
Entity type:Organization
Organization Name:FAMILY HEALTH CARE & MINOR EMERGENCY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT-REID
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-373-2400
Mailing Address - Street 1:PO BOX 660
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:OK
Mailing Address - Zip Code:73078-0660
Mailing Address - Country:US
Mailing Address - Phone:405-373-2400
Mailing Address - Fax:405-373-4400
Practice Address - Street 1:11109 SURREY HILLS BLVD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8155
Practice Address - Country:US
Practice Address - Phone:405-373-2400
Practice Address - Fax:405-373-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200010210BMedicaid
OK900522084Medicare PIN