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General NPI Number Information
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NPI Number | 1639689185
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Entity Type | Organization
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Legal Business Name | ZENA AREA COMMUNITY CLINIC, PLLC, MARCIA MATTHEWS SOLE MEMBER
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 37940 US HWY 59 N
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City | JAY
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State | OK
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Zip | 74346-7434
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Country | US
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Telephone | 918-964-6425
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Fax | 918-786-2402
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Provider Business Mailing Address
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Address Line | 52390 E 333 RD
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City | JAY
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State | OK
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Zip | 74346-5198
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Country | US
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Telephone | 918-919-2272
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Fax | 918-786-2402
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Authorized Official
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Title or Position | SOLE MEMBER OF S CORPORATION IN OK
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Name | DR. MARCIA KAY MATTHEWS
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Credential | MD
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Telephone | 918-919-2272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 19451
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 19451
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License Number State | OK
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