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NPI Code Detail

MEDICARE: COLLINSVILLE FAMILY CLINIC, INC.

MEDICARE: COLLINSVILLE 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
1207Q00000XFamily Medicine Physician1872OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11801890454OTHEROKNPI INDIVIDUAL
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235259573
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLLINSVILLE FAMILY CLINIC, INC.
Provider Business Mailing Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-6022
Fax Number : 918-371-3168
Provider Business Practice Location Address
First Line : 1205 W MAIN ST
Second Line :
City : COLLINSVILLE
State : OK
Zip : 74021-3114
Country : US
Telephone Number : 918-371-6022
Fax Number : 918-371-3168
Authorized Official
Title or Position : OWNER
Name : DR. JERRY D. PATTON
Credential : D.O.
Telephone Number : 918-371-6022
Provider Enumeration Date : 03/30/2007
Last Update Date : 03/12/2009

Similar Medicare Providers

1801890454 — DR. JERRY D. PATTON DO
Practice Location Address:
1205 W MAIN ST
COLLINSVILLE, OK
74021-3114
Practice Phone: 918-938-0040
Practice Fax: 918-938-0056
1578544086 — DR. JERRY C CRAIN D.O.
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Practice Fax: 918-371-0584
1699756957 — DR. FRED M INGRAM D.O.
Practice Location Address:
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COLLINSVILLE, OK
74021-3114
Practice Phone: 918-371-5885
Practice Fax: 918-371-5986
1336185222 — COLLINSVILLE FAMILY PHARMACY LC
Practice Location Address:
1205 W MAIN ST STE A
COLLINSVILLE, OK
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Practice Fax: 918-371-0268
1114085214 — SHERRI LAVERNE CLARK DPH
Practice Location Address:
1205 W MAIN ST
COLLINSVILLE, OK
74021-3114
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Practice Fax: 918-371-0268
1619035722 — AL THARYN NACTHIGALL DPH
Practice Location Address:
1205 W MAIN ST
COLLINSVILLE, OK
74021-3114
Practice Phone: 918-371-2547
Practice Fax: 918-371-0268

Directions to “COLLINSVILLE FAMILY CLINIC, INC. ” Practice Location

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