Provider Demographics
NPI:1992537211
Name:OUR FAMILY DOCTOR LLC
Entity type:Organization
Organization Name:OUR FAMILY DOCTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHILDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-530-9999
Mailing Address - Street 1:12702 E 86TH ST N
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-2548
Mailing Address - Country:US
Mailing Address - Phone:918-274-9300
Mailing Address - Fax:
Practice Address - Street 1:12702 E 86TH ST N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-2548
Practice Address - Country:US
Practice Address - Phone:918-274-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty