Organization Name: | NEXT GENERATION FAMILY MEDICAL CLINIC, LLC |
NPI Number: | 1548646052 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHELE BUCHOLTZ (PRESIDENT) |
Mailing Address: | 1102 W Cherokee St Ste A Wagoner |
State: | OK US |
Postal Code: | 744674600 |
Phone Number: | 9182014502 |
Fax Number: | 9182014503 |
NPI Enumeration Date: | 08/06/2015 |
NPI Last Update Date: | 02/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 4383 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |