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General NPI Number Information
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NPI Number | 1982233656
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Entity Type | Organization
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Legal Business Name | RURAL WELLNESS FAIRFAX INC
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Dates
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Enumeration Date | 04/05/2020
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 535 6TH ST
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City | PAWNEE
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State | OK
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Zip | 74058-2542
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Country | US
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Telephone | 918-762-3942
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Fax | 918-762-4675
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Provider Business Mailing Address
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Address Line | 2524 N BROADWAY
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City | EDMOND
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State | OK
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Zip | 73034-4172
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Country | US
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Telephone | 949-322-4337
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELIZABETH J PUSEY
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Credential |
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Telephone | 949-645-2321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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