Healthcare Provider Details

I. General information

NPI: 1528417409
Provider Name (Legal Business Name): VALLEY FAMILY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 BURR AVE
PAULS VALLEY OK
73075-3848
US

IV. Provider business mailing address

106 BURR AVE
PAULS VALLEY OK
73075-3848
US

V. Phone/Fax

Practice location:
  • Phone: 405-238-4633
  • Fax: 405-238-4690
Mailing address:
  • Phone: 405-238-4633
  • Fax: 405-238-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateOK

VIII. Authorized Official

Name: DR. SUSAN J JONES
Title or Position: PRESIDENT
Credential: D.O.
Phone: 405-238-4633