Healthcare Provider Details

I. General information

NPI: 1639100290
Provider Name (Legal Business Name): BOUNDS FAMILY CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W CHEROKEE ST
LINDSAY OK
73052-4212
US

IV. Provider business mailing address

308 W CHEROKEE ST
LINDSAY OK
73052-4212
US

V. Phone/Fax

Practice location:
  • Phone: 405-756-1499
  • Fax: 405-756-1550
Mailing address:
  • Phone: 405-756-1499
  • Fax: 405-756-1550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3177
License Number StateOK

VIII. Authorized Official

Name: DR. GAYLE D BOUNDS
Title or Position: OWNER
Credential: DO
Phone: 405-756-1499