# CMG FAMILY CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CMG FAMILY CLINIC LLC
- **Other names:** Enlow Family Practice
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1659568301
- **Legal business name:** CMG FAMILY CLINIC LLC
- **Authorized official:** LISA A SWARER (MANAGER)
- **Authorized official phone:** (918) 453-1234

## Contact information

- **Practice address:** 1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
- **Practice address phone:** (918) 453-1234
- **Practice address fax:** (918) 453-9107
- **Mailing address:** 1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
- **Mailing address phone:** (918) 453-1234
- **Mailing address fax:** (918) 453-9107

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | R0067005 | OK | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 04/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 600522432 | MEDICARE GROUP NUMBER | OK |