| Broken Bow Family Clinic Llc | |
|
115 W 1st St Broken Bow OK 74728-3901 | |
| (580) 584-5551 | |
| (877) 697-8948 |
| Full Name | Broken Bow Family Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 115 W 1st St, Broken Bow, Oklahoma |
| Authorized Official Name and Position | Lauren Dawn Ragland (OFFICE MANAGER) |
| Authorized Official Contact | 5805845551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Broken Bow Family Clinic Llc 115 W 1st St Broken Bow OK 74728-3901 Ph: (580) 584-5551 | Broken Bow Family Clinic Llc 115 W 1st St Broken Bow OK 74728-3901 Ph: (580) 584-5551 |
| NPI Number | 1902426489 |
|---|---|
| Provider Enumeration Date | 04/24/2020 |
| Last Update Date | 04/09/2024 |
| Medicare PECOS PAC ID | 9234555871 |
|---|---|
| Medicare Enrollment ID | O20200813001792 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902426489 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Leslie Orr Battles |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588204465 PECOS PAC ID: 0143646786 Enrollment ID: I20200813001844 |
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