NPIMap

Organization Active NPI

Midway Medical Clinic

  • Family Medicine Physician
  • Midwest City, OK
National Provider Identifier
1144307554
Registry record updated Jul 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MIDWAY MEDICAL CLINIC
Practice address
351 N Air Depot Blvd
Suite BB
Midwest City, OK 73110-1700
Phone
(405) 610-3600
Fax
(405) 610-3607
NPI assigned
Nov 1, 2006
Last updated
Jul 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2012

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

Authorized official

Name
McKinley Boatner, PA
Title
Ceo
Phone
(405) 610-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

351 N Air Depot Blvd
Suite BB
Midwest City, OK 73110-1700

Mailing address

PO Box 30739
Midwest City, OK 73140
Phone (405) 610-3600

Other identifiers 2

IdentifierTypeStateIssuer
200015390AMedicaidOK
200015390BMedicaidOK

National Provider Directory

National Provider Directory

Locations

351 N Air Depot Blvd
Ste Bb
Midwest City, OK 73110
Phone (405) 610-3600

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341446400000",
    "number": "1144307554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30739",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "73140",
            "telephone_number": "405-610-3600",
            "fax_number": "405-610-3607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 N AIR DEPOT BLVD",
            "address_2": "SUITE BB",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731101700",
            "telephone_number": "405-610-3600",
            "fax_number": "405-610-3607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2012-07-05",
        "status": "A",
        "authorized_official_last_name": "BOATNER",
        "authorized_official_first_name": "MCKINLEY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "405-610-3600",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200015390A",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200015390B",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Midwest City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2012; 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.