Healthcare Provider Details

I. General information

NPI: 1407971492
Provider Name (Legal Business Name): HUSSAINS FAMILY PRACTICE RHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E MAIN ST
WILBURTON OK
74578-4229
US

IV. Provider business mailing address

139 E MAIN ST
WILBURTON OK
74578-4229
US

V. Phone/Fax

Practice location:
  • Phone: 918-465-5727
  • Fax: 918-465-3311
Mailing address:
  • Phone: 918-465-5727
  • Fax: 918-465-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number89829
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. AHMER HUSSAIN
Title or Position: OWNER
Credential: MD
Phone: 918-465-5727