Provider Demographics
NPI:1972964666
Name:SALLISAW FAMILY MEDICINE, L.L.C.
Entity type:Organization
Organization Name:SALLISAW FAMILY MEDICINE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-495-6772
Mailing Address - Street 1:5 TENNYSON PLACE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131
Mailing Address - Country:US
Mailing Address - Phone:504-495-6772
Mailing Address - Fax:
Practice Address - Street 1:104 SOUTH OAK ST
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955
Practice Address - Country:US
Practice Address - Phone:918-775-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty