Organization
FAMILY MEDICAL CLINIC
Active
Other names
Jason McHenry PA INC
Organization subpart
No
Provider details
NPI number
Authorized official
JASON R MCHNERY PA (OWNER)
(580) 584-7210
Entity
Organization
Contact information
Practice address
110 W 1ST ST, BROKEN BOW, OK 74728-3902
(580) 584-7210
Mailing address
110 W 1ST STREET, BROKEN BOW, OK 74728-3901
(580) 584-7210
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA1255
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015540B
—
OK
Enumeration date
04/24/2007
Last updated
08/12/2008
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