Organization
CMG FAMILY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A SWARER (OPERATIONS MANAGER)
(918) 453-1234
Entity
Organization
Contact information
Practice address
1317 S DEWEY AVE, WAGONER, OK 74467-7013
(918) 485-9696
(918) 485-1701
Mailing address
1317 S DEWEY AVE, WAGONER, OK 74467-7013
(918) 485-9696
(918) 485-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21712
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600522432
MEDICARE GROUP PTAN
OK
01
—
OK100338
MEDICARE PTAN
OK
Enumeration date
04/07/2008
Last updated
05/14/2008
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