Healthcare Provider Details

I. General information

NPI: 1609584978
Provider Name (Legal Business Name): MARANATHA FAMILY COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S 28TH ST
CLINTON OK
73601-3701
US

IV. Provider business mailing address

2409 SUNUP DR
CLINTON OK
73601-2905
US

V. Phone/Fax

Practice location:
  • Phone: 580-323-8747
  • Fax:
Mailing address:
  • Phone: 908-887-2724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EJEEHI UMOBUARIE
Title or Position: MEMBER
Credential: MD
Phone: 908-887-2724