Healthcare Provider Details

I. General information

NPI: 1639689185
Provider Name (Legal Business Name): ZENA AREA COMMUNITY CLINIC, PLLC, MARCIA MATTHEWS SOLE MEMBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37940 US HWY 59 N
JAY OK
74346-7434
US

IV. Provider business mailing address

52390 E 333 RD
JAY OK
74346-5198
US

V. Phone/Fax

Practice location:
  • Phone: 918-964-6425
  • Fax: 918-786-2402
Mailing address:
  • Phone: 918-919-2272
  • Fax: 918-786-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number19451
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number19451
License Number StateOK

VIII. Authorized Official

Name: DR. MARCIA KAY MATTHEWS
Title or Position: SOLE MEMBER OF S CORPORATION IN OK
Credential: MD
Phone: 918-919-2272