MEDICARE: HARVARD FAMILY CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1308	OK
2	207Q00000X	Family Medicine Physician	1460	OK

General Provider Information

NPI Number	:	1215151600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVARD FAMILY CLINIC INC

Provider Business Mailing Address
First Line	:	3315 E 47TH PL
Second Line	:	SUITE 111
City	:	TULSA
State	:	OK
Zip	:	74135-2914
Country	:	US
Telephone Number	:	918-748-8111
Fax Number	:	918-744-5284

Provider Business Practice Location Address
First Line	:	3315 E 47TH PL
Second Line	:	SUITE 111
City	:	TULSA
State	:	OK
Zip	:	74135-2914
Country	:	US
Telephone Number	:	918-748-8111
Fax Number	:	918-744-5284

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWIN A BERGER
Credential	:	DO
Telephone Number	:	918-748-8111

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	11/10/2009

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Directions to “HARVARD FAMILY CLINIC INC ” Practice Location

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