=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760665400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIGHBORHOOD FAMILY MEDICAL CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2007
-----------------------------------------------------
Last Update Date | 02/14/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 821 S PINE ST
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-533-1332
-----------------------------------------------------
Fax | 405-533-1704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 821 S PINE ST
-----------------------------------------------------
City | STILLWATER
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74074-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-533-1332
-----------------------------------------------------
Fax | 405-533-1704
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. JENNIFER GAIL PERKINS
-----------------------------------------------------
Credential | MS, ARNP
-----------------------------------------------------
Telephone | 405-533-1332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | R0073110
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------