# LANE FAMILY CLINIC LLC

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

## Provider details

- **NPI number:** 1942810056
- **Authorized official:** SHAMI LYNN FOWLER CNP (OWNER)
- **Authorized official phone:** (580) 212-0303

## Contact information

- **Practice address:** 207 WEST 10TH STREET, WRIGHT CITY, OK 74766
- **Practice address phone:** (580) 981-2104
- **Practice address fax:** (580) 981-2105
- **Mailing address:** PO BOX 650, WRIGHT CITY, OK 74766-0650
- **Mailing address phone:** (580) 981-2104
- **Mailing address fax:** (580) 981-2105

## Taxonomy

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

## Other

- **Enumeration date:** 08/04/2020
- **Last updated:** 08/04/2020