Organization Name: | KIAMICHI FAMILY MEDICAL CENTER INC. |
NPI Number: | 1184633786 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY GILBREATH (CEO) |
Mailing Address: | 601 Se Washington St Idabel |
State: | OK US |
Postal Code: | 747453319 |
Phone Number: | 5802866688 |
Fax Number: | 5802866699 |
NPI Enumeration Date: | 08/05/2006 |
NPI Last Update Date: | 09/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |