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General NPI Number Information
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NPI Number | 1265194807
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Entity Type | Organization
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Legal Business Name | FAITH FAMILY CLINIC PLLC
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Dates
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Enumeration Date | 10/11/2021
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 4125 W OWEN K GARRIOTT RD STE A-1
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City | ENID
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State | OK
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Zip | 73703-4820
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Country | US
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Telephone | 580-616-3007
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Fax | 580-324-8008
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Provider Business Mailing Address
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Address Line | 4201 EVANDALE DR
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City | ENID
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State | OK
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Zip | 73703-7301
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Country | US
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Telephone | 580-227-7448
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/CEO
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Name | DR. JAMI BENTON
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Credential | MD
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Telephone | 580-227-7448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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