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General NPI Number Information
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NPI Number | 1902426489
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Entity Type | Organization
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Legal Business Name | BATTLES BROKEN BOW FAMILY CLINIC, LLC
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Dates
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Enumeration Date | 04/24/2020
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 115 W 1ST ST
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City | BROKEN BOW
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State | OK
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Zip | 74728-3901
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Country | US
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Telephone | 580-584-5551
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Fax | 877-697-8948
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Provider Business Mailing Address
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Address Line | 115 W 1ST ST
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City | BROKEN BOW
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State | OK
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Zip | 74728-3901
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Country | US
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Telephone | 580-584-5551
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Fax | 580-584-5552
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAUREN DAWN RAGLAND
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Credential |
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Telephone | 580-584-5551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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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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