| Lane Family Clinic Llc | |
|
207 West 10th Street Wright City OK 74766 | |
| (580) 981-2104 | |
| (580) 981-2105 |
| Full Name | Lane Family Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 207 West 10th Street, Wright City, Oklahoma |
| Authorized Official Name and Position | Shami Lynn Fowler (OWNER) |
| Authorized Official Contact | 5802120303 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lane Family Clinic Llc Po Box 650 Wright City OK 74766-0650 Ph: (580) 981-2104 | Lane Family Clinic Llc 207 West 10th Street Wright City OK 74766 Ph: (580) 981-2104 |
| NPI Number | 1942810056 |
|---|---|
| Provider Enumeration Date | 08/04/2020 |
| Last Update Date | 08/04/2020 |
| Medicare PECOS PAC ID | 3173943131 |
|---|---|
| Medicare Enrollment ID | O20201014000871 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942810056 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Shami Lynn Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104441849 PECOS PAC ID: 4082034947 Enrollment ID: I20201014001088 |
Good Honest Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 207 W 10th St, Wright City, OK 74766 Phone: 580-981-2445 Fax: 580-987-2586 |