=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841941887
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ENTRUST DPC PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2022
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 917 N MAIN ST
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73737-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-227-8647
-----------------------------------------------------
Fax | 580-603-8602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 917 N MAIN ST
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73737-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-227-8647
-----------------------------------------------------
Fax | 580-603-8602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/MEDICAL DIRECTOR
-----------------------------------------------------
Name | ANDREA E MCEACHERN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 580-227-8647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------