# MIDWAY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144307554
- **Authorized official:** MCKINLEY BOATNER PA (CEO)
- **Authorized official phone:** (405) 610-3600

## Contact information

- **Practice address:** 351 N AIR DEPOT BLVD, SUITE BB, MIDWEST CITY, OK 73110-1700
- **Practice address phone:** (405) 610-3600
- **Practice address fax:** (405) 610-3607
- **Mailing address:** PO BOX 30739, MIDWEST CITY, OK 73140
- **Mailing address phone:** (405) 610-3600
- **Mailing address fax:** (405) 610-3607

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/01/2006
- **Last updated:** 07/05/2012