Healthcare Provider Details

I. General information

NPI: 1972863041
Provider Name (Legal Business Name): FGG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 JENKINS AVE
NORMAN OK
73069-4951
US

IV. Provider business mailing address

755 JENKINS AVE
NORMAN OK
73069-4951
US

V. Phone/Fax

Practice location:
  • Phone: 405-701-2420
  • Fax: 405-701-2447
Mailing address:
  • Phone: 405-701-2420
  • Fax: 405-701-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PHILICIA M GROVES
Title or Position: NURSE PRACTITIONER, ADMINISTRATOR
Credential: NP
Phone: 405-701-2420