# FAMILY MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jason McHenry PA INC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912126335
- **Authorized official:** JASON R MCHNERY PA (OWNER)
- **Authorized official phone:** (580) 584-7210

## Contact information

- **Practice address:** 110 W 1ST ST, BROKEN BOW, OK 74728-3902
- **Practice address phone:** (580) 584-7210
- **Mailing address:** 110 W 1ST STREET, BROKEN BOW, OK 74728-3901
- **Mailing address phone:** (580) 584-7210

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | PA1255 | OK | Yes |

## Other

- **Enumeration date:** 04/24/2007
- **Last updated:** 08/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200015540B | — | OK |