=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942331061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN PLAINS FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 FRISCO AVE
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73601-3306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-323-2700
-----------------------------------------------------
Fax | 580-323-2276
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 90 N 30TH ST SUITE 4
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73601-3101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-323-0232
-----------------------------------------------------
Fax | 580-331-1410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARK BLAINE MANN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 580-323-0232
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20775
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------