Provider Demographics
NPI:1285379909
Name:MILLS FAMILY CLINIC, PLLC
Entity type:Organization
Organization Name:MILLS FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVISOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:918-304-9608
Mailing Address - Street 1:5821 W ORLANDO CIR
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-1153
Mailing Address - Country:US
Mailing Address - Phone:918-304-9608
Mailing Address - Fax:
Practice Address - Street 1:108 W RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4005
Practice Address - Country:US
Practice Address - Phone:580-278-6804
Practice Address - Fax:888-498-4576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty