MISSION STREET MEDICAL CLINIC INC NPI 1972600112

NPI Information

NPI: 1972600112
Provider Name: MISSION STREET MEDICAL CLINIC INC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
615 S MISSION ST STE A
SAPULPA, OK
ZIP 74066
Phone: (918) 224-9555
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MISSION STREET MEDICAL CLINIC INC is a family medicine in Sapulpa, OK. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. MISSION STREET MEDICAL CLINIC INC NPI is 1972600112. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

615 S MISSION ST STE A
SAPULPA, OK
ZIP 74066-635
Phone: (918) 224-9555
Fax: (918) 224-8001

The provider's authorized official is Dianna M Willis .
The authorized official title is Doctor and has the following contact phone number (918) 224-9555.

The enumeration date for this NPI number is 9/20/2006 and was last updated on 12/30/2010.

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	207Q00000X	Family Medicine		2405	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	Other Provider Identifier Issuer
1	C05052	OTHER	OKLAHOMA	RAILROAD MEDICARE
2	E45378	MEDICARE UPIN	OKLAHOMA
3	700522111	MEDICARE PIN	OKLAHOMA
4	=========003	OTHER	OKLAHOMA	BLUE CROSS BLUE SHIELD
5	100739110A	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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