Lane Family Clinic Llc | |
207 West 10th Street Wright City OK 74766 | |
(580) 981-2104 | |
(580) 981-2105 |
Full Name | Lane Family Clinic Llc |
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Speciality | Family Medicine |
Location | 207 West 10th Street, Wright City, Oklahoma |
Authorized Official Name and Position | Shami Lynn Fowler (OWNER) |
Authorized Official Contact | 5802120303 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Lane Family Clinic Llc Po Box 650 Wright City OK 74766-0650 Ph: (580) 981-2104 | Lane Family Clinic Llc 207 West 10th Street Wright City OK 74766 Ph: (580) 981-2104 |
NPI Number | 1942810056 |
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Provider Enumeration Date | 08/04/2020 |
Last Update Date | 08/04/2020 |
Medicare PECOS PAC ID | 3173943131 |
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Medicare Enrollment ID | O20201014000871 |
Identifier | Type | State | Issuer |
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1942810056 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Shami Lynn Fowler |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1104441849 PECOS PAC ID: 4082034947 Enrollment ID: I20201014001088 |
Good Honest Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 W 10th St, Wright City, OK 74766 Phone: 580-981-2445 Fax: 580-987-2586 |