| Integris Canadian Valley Family Care Clinic | |
|
1468 N Mustang Rd Mustang OK 73064-0000 | |
| (405) 376-1800 | |
| (405) 376-1856 |
| Full Name | Integris Canadian Valley Family Care Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 1468 N Mustang Rd, Mustang, Oklahoma |
| Authorized Official Name and Position | Jeffrey M Brown (VP OF PHYSICIAN PRACTICE MANAGEMENT) |
| Authorized Official Contact | 5805481367 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Integris Canadian Valley Family Care Clinic Po Box 960033 Oklahoma City OK 73196-0033 Ph: (580) 548-1367 | Integris Canadian Valley Family Care Clinic 1468 N Mustang Rd Mustang OK 73064-0000 Ph: (405) 376-1800 |
| NPI Number | 1962403030 |
|---|---|
| Provider Enumeration Date | 08/10/2005 |
| Last Update Date | 01/02/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962403030 | NPI | - | NPPES |
| 200014470C | Other | OK | MEDICAID SC |
| 200014470D | Medicaid | OK | |
| 200014470B | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Secondary |
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