# NEXT GENERATION FAMILY MEDICAL CLINIC, LLC

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

## Provider details

- **NPI number:** 1548646052
- **Authorized official:** DR. MICHELE BUCHOLTZ D.O.,PH.D (PRESIDENT)
- **Authorized official phone:** (918) 201-4502

## Contact information

- **Practice address:** 1102 W CHEROKEE ST STE A, WAGONER, OK 74467-4600
- **Practice address phone:** (918) 201-4502
- **Practice address fax:** (918) 201-4503
- **Mailing address:** 1102 W CHEROKEE ST STE A, WAGONER, OK 74467-4600
- **Mailing address phone:** (918) 201-4502
- **Mailing address fax:** (918) 201-4503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 4383 | OK | Yes |

## Other

- **Enumeration date:** 08/06/2015
- **Last updated:** 02/22/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1275754780 | — | OK |