| Organization Name: | ROLAND PRIMARY CARE CLINIC LLC |
| NPI Number: | 1053730903 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | FREDERICK J FUOCO (PRESIDENT) |
| Mailing Address: | 309 E Ray Fine Blvd Roland |
| State: | OK US |
| Postal Code: | 749545160 |
| Phone Number: | 9185036276 |
| Fax Number: | 9418503627 |
| NPI Enumeration Date: | 04/08/2014 |
| NPI Last Update Date: | 04/08/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |