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General NPI Number Information
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NPI Number | 1417349697
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Entity Type | Organization
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Legal Business Name | USAF
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 02/25/2015
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Provider Practice Location Address
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Address Line | 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705-5103
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Country | US
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Telephone | 317-431-1271
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Fax |
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Provider Business Mailing Address
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Address Line | 527 GOTT RD
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City | ENID
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State | OK
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Zip | 73705-5103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FAMILY PRACTICE PA
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Name | MELISSA J LINCOLN
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Credential |
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Telephone | 317-431-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number |
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License Number State |
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