MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC LLC NPI 1154719169

NPI Information

NPI: 1154719169
Provider Name: MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 37D2092076

Address:
309 W MAIN ST
STROUD, OK
ZIP 74079
Phone: (918) 987-0067
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MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC is a primary care clinic center in Stroud, OK. MAIN STREET FAMILY HEALTHCARE NURSE PRACTITIONER CLINIC, LLC NPI is 1154719169. The provider is registered as an organization entity type.

The provider's business location address is:

309 W MAIN ST
STROUD, OK
ZIP 74079-611
Phone: (918) 987-0067

The provider's authorized official is Bronwyn L. Howard .
The authorized official title is Owner/operator and has the following contact phone number (918) 950-5053.

The CLIA number assigned to this NPI record is 37D2092076 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/27/2014 and was last updated on 12/18/2015.

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
1	261QP2300X	Clinic/Center	Primary Care	R0052024	OKLAHOMA	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
1	246733204	MEDICARE UPIN	OKLAHOMA
2	200121770A	MEDICAID	OKLAHOMA
3	2005513360A	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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