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General NPI Number Information
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NPI Number | 1497186357
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Entity Type | Organization
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Legal Business Name | CARPENTER CLINIC PLLC
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 201 N MONTE VISTA ST STE A
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City | ADA
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State | OK
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Zip | 74820-7213
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Country | US
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Telephone | 580-332-4418
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Fax | 580-332-0324
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Provider Business Mailing Address
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Address Line | 201 N MONTE VISTA ST STE A
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City | ADA
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State | OK
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Zip | 74820-7220
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Country | US
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Telephone | 580-332-4418
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Fax | 580-332-0324
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Authorized Official
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Title or Position | OWNER
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Name | DR. JO ANN CARPENTER
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Credential | MD
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Telephone | 580-332-4418
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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 | 11778
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License Number State | OK
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