Organization
CMG FAMILY CLINIC LLC
Active
Parent organization
CMG FAMILY CLINIC LLC
Other names
Enlow Family Practice
Organization subpart
Yes
Provider details
NPI number
Legal business name
CMG FAMILY CLINIC LLC
Authorized official
LISA A SWARER (MANAGER)
(918) 453-1234
Entity
Organization
Contact information
Practice address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Mailing address
1203 E ROSS BYP, SUITE A, TAHLEQUAH, OK 74464-4133
(918) 453-1234
(918) 453-9107
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
R0067005
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600522432
MEDICARE GROUP NUMBER
OK
Enumeration date
09/26/2007
Last updated
04/29/2008
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