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General NPI Number Information
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NPI Number | 1508461856
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Entity Type | Organization
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Legal Business Name | WALKUP FAMILY MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 1302 S LYNN LN
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City | IDABEL
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State | OK
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Zip | 74745-6860
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Country | US
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Telephone | 405-639-7771
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Fax |
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Provider Business Mailing Address
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Address Line | 1302 S LYNN LN
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City | IDABEL
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State | OK
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Zip | 74745-6860
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Country | US
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Telephone | 580-286-3993
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Fax | 580-286-3967
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Authorized Official
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Title or Position | OWNER
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Name | DR. STORMY WALKUP
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Credential | DO
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Telephone | 405-639-7771
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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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