Provider Demographics
NPI:1073376604
Name:GARRISON EXEMPLAR COMPANY
Entity type:Organization
Organization Name:GARRISON EXEMPLAR COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:405-517-6539
Mailing Address - Street 1:3414 NW CACHE RD STE F
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3878
Mailing Address - Country:US
Mailing Address - Phone:580-265-8871
Mailing Address - Fax:
Practice Address - Street 1:3414 NW CACHE RD STE F
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3878
Practice Address - Country:US
Practice Address - Phone:580-265-8871
Practice Address - Fax:580-265-8849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467554824OtherPROVIDER NPI
1326467499OtherINDIVIDUAL NPI
OK200756440AMedicaid