Healthcare Provider Details

I. General information

NPI: 1346131182
Provider Name (Legal Business Name): FEDCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 N BROADWAY AVE STE B
OKLAHOMA CITY OK
73103-4407
US

IV. Provider business mailing address

PO BOX 152
OKLAHOMA CITY OK
73101-0152
US

V. Phone/Fax

Practice location:
  • Phone: 405-702-7246
  • Fax: 405-609-6679
Mailing address:
  • Phone: 405-702-7246
  • Fax: 405-609-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: EMILI GRAGG
Title or Position: MANAGER
Credential:
Phone: 405-219-2651