Organization
MIDWAY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MCKINLEY BOATNER PA (CEO)
(405) 610-3600
Entity
Organization
Contact information
Practice address
351 N AIR DEPOT BLVD, SUITE BB, MIDWEST CITY, OK 73110-1700
(405) 610-3600
(405) 610-3607
Mailing address
PO BOX 30739, MIDWEST CITY, OK 73140
(405) 610-3600
(405) 610-3607
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015390A
—
OK
05
—
200015390B
—
OK
Enumeration date
11/01/2006
Last updated
07/05/2012
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