Provider Demographics
NPI:1962129114
Name:BROWNS FAMILY MEDICAL CLINIC
Entity type:Organization
Organization Name:BROWNS FAMILY MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-463-2095
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:WARNER
Mailing Address - State:OK
Mailing Address - Zip Code:74469-0679
Mailing Address - Country:US
Mailing Address - Phone:918-463-2095
Mailing Address - Fax:918-463-2097
Practice Address - Street 1:402 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:WARNER
Practice Address - State:OK
Practice Address - Zip Code:74469-2302
Practice Address - Country:US
Practice Address - Phone:918-463-2095
Practice Address - Fax:918-675-5050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200789850AMedicaid