Provider Demographics
NPI:1528821584
Name:FWC MEDICAL CENTERS PLLC
Entity type:Organization
Organization Name:FWC MEDICAL CENTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:405-227-5732
Mailing Address - Street 1:2304 NW 156TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5065
Mailing Address - Country:US
Mailing Address - Phone:405-227-5732
Mailing Address - Fax:813-877-6941
Practice Address - Street 1:3000 LANGLEY AVE STE 402
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-4702
Practice Address - Country:US
Practice Address - Phone:405-227-5732
Practice Address - Fax:813-877-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty