# COMMUNITY FAMILY MEDICAL CLINIC, LLC.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COMMUNITY FAMILY MEDICAL CLINIC LLC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912568304
- **Legal business name:** COMMUNITY FAMILY MEDICAL CLINIC LLC.
- **Authorized official:** MR. TY G MATLOCK (OWNER)
- **Authorized official phone:** (479) 561-8811

## Contact information

- **Practice address:** 1202 FORT STREET, BARLING, AR 72923
- **Practice address phone:** (918) 427-7581
- **Practice address fax:** (918) 427-7798
- **Mailing address:** P.O BOX 988, ROLAND, OK 74954
- **Mailing address phone:** (918) 427-7581
- **Mailing address fax:** (918) 427-7798

## Taxonomy

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

## Other

- **Enumeration date:** 06/26/2019
- **Last updated:** 06/26/2019