Windsor Park Medical Clinic

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1779 Issued in OK

Legal business name

WINDSOR PARK MEDICAL CLINIC

Practice address

2512 N Meridian Ave
Oklahoma City, OK 73107-1035

Phone

(405) 605-5415

Fax

(405) 605-5310

NPI assigned

Nov 14, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy Louise Fagan, P.A.C.

Title

Physician Assistant

Phone

(405) 605-5415

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226620800000",
    "number": "1104070259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2512 N MERIDIAN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731071035",
            "telephone_number": "405-605-5415",
            "fax_number": "405-605-5310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2512 N MERIDIAN AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731071035",
            "telephone_number": "405-605-5415",
            "fax_number": "405-605-5310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINDSOR PARK MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-14",
        "last_updated": "2008-11-14",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "405-605-5415",
        "authorized_official_credential": "P.A.C."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "1779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Windsor Dental Partners PLLC
• Windsor Hills Nursing Center, LLC
• Windsor Hills Operating LLC
• Windsor Hills SNF Operations LLC
• Windsor Manor Assisted Living
• Windsor Park Medical Clinic
• Windsor Park Medical Clinic, LLC
• Windsor Park Pharmacy
• Windsor Park Pharmacy of Oklahoma LLC
• Windsor Park Pharmacy, LLC

• Physician Assistant in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.