Organization
PACK FAMILY CLINIC, PLLC
Active
Other names
Family Physician
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VALERIE M PACK DO (FAMILY PHYSICIAN)
(918) 728-4942
Entity
Organization
Contact information
Practice address
1509 AUGUSTA DR, ADA, OK 74820-8576
(918) 728-4942
(918) 770-8456
Mailing address
1509 AUGUSTA DR, ADA, OK 74820-8576
(918) 728-4942
(918) 770-8456
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5857
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200654670A
—
OK
Enumeration date
11/06/2017
Last updated
08/23/2021
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