Healthcare Provider Details

I. General information

NPI: 1396987707
Provider Name (Legal Business Name): HEALTHY FAMILIES MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 09/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MAIN ST
HENNESSEY OK
73742-1019
US

IV. Provider business mailing address

500 N MAIN ST
HENNESSEY OK
73742-1019
US

V. Phone/Fax

Practice location:
  • Phone: 405-853-2995
  • Fax: 405-853-2996
Mailing address:
  • Phone: 405-853-2995
  • Fax: 405-853-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24563
License Number StateOK

VIII. Authorized Official

Name: DR. CHARLES W. FERRELL
Title or Position: OWNER
Credential: M.D.
Phone: 405-853-2995