Organization
SOVEREIGN FAMILY CLINIC, LLC
Active
Other names
Sovereign Family Practice Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRIS M ANOATUBBY (PRESIDENT, SOVEREIGN)
(580) 272-5160
Entity
Organization
Contact information
Practice address
1007 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-8700
(580) 421-8785
Mailing address
1007 N COUNTRY CLUB RD, ADA, OK 74820-2847
(580) 421-8700
(580) 421-8785
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
04/25/2011
Last updated
06/18/2015
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