MEDICARE: MUSKOGEE FAMILY PRACTICE

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	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1629766407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUSKOGEE FAMILY PRACTICE

Provider Business Mailing Address
First Line	:	1118 W BROADWAY ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-6246
Country	:	US
Telephone Number	:	918-681-7554
Fax Number	:

Provider Business Practice Location Address
First Line	:	1118 W BROADWAY ST
Second Line	:
City	:	MUSKOGEE
State	:	OK
Zip	:	74401-6246
Country	:	US
Telephone Number	:	918-681-7554
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LISA S BRISCOE
Credential	:	CPC, CPB, CRC
Telephone Number	:	918-808-7626

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	12/04/2025

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Directions to “MUSKOGEE FAMILY PRACTICE ” Practice Location

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