Healthcare Provider Details

I. General information

NPI: 1033129333
Provider Name (Legal Business Name): PUTNAM NORTH FAMILY MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11220 N ROCKWELL AVE
OKLAHOMA CITY OK
73162-2725
US

IV. Provider business mailing address

11220 N ROCKWELL AVE
OKLAHOMA CITY OK
73162-2725
US

V. Phone/Fax

Practice location:
  • Phone: 405-722-9474
  • Fax: 405-722-9463
Mailing address:
  • Phone: 405-722-9474
  • Fax: 405-722-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN R PITTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 405-722-9474