Pack Family Clinic, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5857 Issued in OK

Legal business name

PACK FAMILY CLINIC, PLLC

Practice address

1509 Augusta Dr
Ada, OK 74820-8576

Phone

(918) 728-4942

Fax

(918) 770-8456

NPI assigned

Nov 6, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Valerie M Pack, DO

Title

Family Physician

Phone

(918) 728-4942

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Physician Doing business as

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

{
    "created_epoch": "1509926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1124531736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 AUGUSTA DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748208576",
            "telephone_number": "918-728-4942",
            "fax_number": "918-770-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 AUGUSTA DR",
            "city": "ADA",
            "state": "OK",
            "postal_code": "748208576",
            "telephone_number": "918-728-4942",
            "fax_number": "918-770-8456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACK FAMILY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-06",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "PACK",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "FAMILY PHYSICIAN",
        "authorized_official_telephone_number": "918-728-4942",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "5857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200654670A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Physician",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Omojasola Omoniyi, MD
• Vicki Orsburn, BA, CADC
• Alisia Ortiz
• Vashti Osborn
• Almalita Owens
• Valerie Marie Pack, D.O.
• Gary L Paddack, MD
• Lyn Page, DDS
• Shrina Parekh, M.D.
• Mahate Ann Parker, M.D.

• Family Medicine Physician in Ada, OK
• Providers in Ada, OK by specialty
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.