Healthcare Provider Details

I. General information

NPI: 1164583878
Provider Name (Legal Business Name): FAMILY PRACTICE OF ELK CITY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W 3RD ST
ELK CITY OK
73644-5205
US

IV. Provider business mailing address

601 W 3RD ST
ELK CITY OK
73644-5205
US

V. Phone/Fax

Practice location:
  • Phone: 580-225-5900
  • Fax:
Mailing address:
  • Phone: 580-225-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10570
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN R PERKINS
Title or Position: PRESIDENT
Credential: MD
Phone: 580-225-5900