Healthcare Provider Details

I. General information

NPI: 1801840368
Provider Name (Legal Business Name): THE FAMILY CARE CENTER OF HARRAH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20826 MAIN ST
HARRAH OK
73045-9755
US

IV. Provider business mailing address

PO BOX 900
HARRAH OK
73045-0900
US

V. Phone/Fax

Practice location:
  • Phone: 405-454-2404
  • Fax: 405-454-6372
Mailing address:
  • Phone: 405-454-2404
  • Fax: 405-454-6372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number2323
License Number StateOK

VIII. Authorized Official

Name: MR. LEN U LACEFIELD JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 405-454-2404