PACK FAMILY CLINIC, PLLC (NPI# 1124531736) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124531736 |
| Entity Type | Organization |
| Organization Name | PACK FAMILY CLINIC, PLLC |
| Other Organization Name | FAMILY PHYSICIAN |
| Practice Address |
1202 W Cherokee St Ste E Wagoner OK 74467-4629 |
| Practice Telephone | 9184851877 |
| Mailing Telephone | 9183980888 |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2017-11-06 |
| Authorized Official Name | DR. VALERIE M PACK (FAMILY PHYSICIAN) |
| Authorized Official Telephone | 9183980888 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5857 | OK | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200654670A | 05 |
| Other Name | Type Code |
|---|---|
| Family Physician | Doing Business As Name - Organization |
| Street Address |
1202 W CHEROKEE ST STE E |
| City | WAGONER |
| State | OK |
| Zip Code | 74467-4629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003099276 | Casey Hanna Md Professional Corporation | Family Medicine | 1202 W Cherokee St Ste E, Wagoner, OK 74467-4629 | 2007-12-11 |
| 1467847921 | Valerie Marie Pack | Emergency Medicine | 1202 W Cherokee St Ste E, Wagoner, OK 74467-4629 | 2015-04-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982251591 | Alesha Lenard | Behavior Technician | 901 S. Harrill Ave, Wagoner, OK 74467 | 2019-08-20 |
| 1679030597 | Lorri Dawn Pitchford | Case Manager/Care Coordinator | Creoks Behavioral Health Services, 109 S Harrill Ave., Wagoner, OK 74467 | 2019-02-27 |
| 1144769399 | Elaina Murray | Technician | 308 Ne 2nd St., Wagoner, OK 74467 | 2017-02-21 |
| 1336699784 | Tommye Evidson | Counselor | 109 Harrill Ave, Wagoner, OK 74467 | 2016-10-10 |
| 1518327857 | Yco Tulsa, Inc | Clinic/Center | 1101a South Mcquarrie, Wagoner, OK 74467 | 2016-02-29 |
| 1396117545 | Sandra Cooper | Behavioral Analyst | 2109 Us-69, Wagoner, OK 74467 | 2015-10-28 |
| 1588051486 | Penny Nye | Counselor | 2109 S.hwy 69, Wagoner, OK 74467 | 2015-04-20 |
| 1376943571 | Justin F Kurtz | Respiratory Therapist, Certified | 1200 W. Cherokee, Suite H Cardiac/pulmonary Rehab, Wagoner, OK 74467 | 2014-08-26 |
| 1780009969 | David H Good | Family Medicine | 1202 W. Cherokee St, Ste E, Wagoner, OK 74467 | 2014-02-25 |
| 1942598875 | Robin Rodriguez-higginbottom | Speech-Language Pathologist | 215 E Cherokee St, Wagoner, OK 74467 | 2011-07-12 |
| Find all providers in zip 74467 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780009969 | David H Good | Family Medicine | 1202 W. Cherokee St, Ste E, Wagoner, OK 74467 | 2014-02-25 |
| 1619153574 | Jillian Ross Riggs | Family Medicine | 29719 E 770 Rd, Wagoner, OK 74467-1015 | 2008-01-10 |
| 1003099276 | Casey Hanna Md Professional Corporation | Family Medicine | 1202 W Cherokee St Ste E, Wagoner, OK 74467-4629 | 2007-12-11 |
| 1275754780 | Michele Bucholtz | Family Medicine | 1102 W Cherokee St, Wagoner, OK 74467-4600 | 2007-05-01 |
| 1457317497 | Bryan Casey Hanna | Family Medicine | 1200 W. Cherokee St, Wagoner, OK 74467 | 2006-04-26 |
| 1669433546 | John Claude Jackson | Family Medicine | 410 E Cherokee St, Wagoner, OK 74467-4708 | 2006-03-30 |
| 1710979315 | Chriss B Roberts | Family Medicine | 1306 Sw 3rd St, Wagoner, OK 74467-5518 | 2005-08-19 |
| 1376064139 | Robyn Farmer | Family Medicine | 410 E Cherokee St, Wagoner, OK 74467-4708 | 2017-07-02 |
| 1134655004 | John Belk Family Practice Pllc | Family Medicine | 1103 W Cherokee St, Wagoner, OK 74467-4621 | 2017-05-11 |
| 1790199982 | John Belk | Family Medicine | 1103 W Cherokee St, Wagoner, OK 74467-4621 | 2014-06-16 |
| Find all providers in WAGONER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.