Organization
N EVANS EINTERPRISES LLC
Active
Other names
Granite Family Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE EVANS (PRESIDENT)
(580) 706-0113
Entity
Organization
Contact information
Practice address
417 N. MAIN, GRANITE, OK 73547
(580) 535-4598
(580) 535-4725
Mailing address
417 NORTH MAIN, P.O. BOX 243, GRANITE, OK 73547-0243
(580) 535-4598
(580) 535-4725
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
OK
363A00000X
Physician Assistant
802
OK
Other
Enumeration date
05/05/2008
Last updated
08/25/2010
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