MEDICARE: WESTERN PLAINS FAMILY MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	20775	OK

General Provider Information

NPI Number	:	1942331061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN PLAINS FAMILY MEDICINE

Provider Business Mailing Address
First Line	:	90 N 30TH ST
Second Line	:	SUITE 4
City	:	CLINTON
State	:	OK
Zip	:	73601-3101
Country	:	US
Telephone Number	:	580-323-0232
Fax Number	:	580-331-1410

Provider Business Practice Location Address
First Line	:	90 N 30TH ST STE 1
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3100
Country	:	US
Telephone Number	:	580-323-0232
Fax Number	:	580-331-1410

Authorized Official
Title or Position	:	OWNER
Name	:	MARK BLAINE MANN
Credential	:
Telephone Number	:	580-323-0232

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	12/08/2025

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