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General NPI Number Information
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NPI Number | 1376356204
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Entity Type | Organization
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Legal Business Name | BLACKWELL FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1009 W FERGUSON AVE
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City | BLACKWELL
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State | OK
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Zip | 74631-5602
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Country | US
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Telephone | 580-363-0052
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Fax | 580-363-0894
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Provider Business Mailing Address
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Address Line | 1009 W FERGUSON AVE
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City | BLACKWELL
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State | OK
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Zip | 74631-5602
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Country | US
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Telephone | 580-363-0052
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Fax | 580-363-0894
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Authorized Official
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Title or Position | OFFICE MANGER
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Name | SARA J FAIR
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Credential |
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Telephone | 580-363-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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