Collinsville Family Clinic, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1872 Issued in OK

Legal business name

COLLINSVILLE FAMILY CLINIC, INC.

Practice address

1205 W Main St
Collinsville, OK 74021-3114

Phone

(918) 371-6022

Fax

(918) 371-3168

NPI assigned

Mar 30, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jerry D. Patton, D.O.

Title

Owner

Phone

(918) 371-6022

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236816000000",
    "number": "1235259573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 W MAIN ST",
            "city": "COLLINSVILLE",
            "state": "OK",
            "postal_code": "740213114",
            "telephone_number": "918-371-6022",
            "fax_number": "918-371-3168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 W MAIN ST",
            "city": "COLLINSVILLE",
            "state": "OK",
            "postal_code": "740213114",
            "telephone_number": "918-371-6022",
            "fax_number": "918-371-3168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLINSVILLE FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2009-03-12",
        "status": "A",
        "authorized_official_last_name": "PATTON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "918-371-6022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "1872",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL",
            "identifier": "1801890454",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100251820A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Collinsville
• City of Sapulpa
• Sherri Laverne Clark, DPH
• Emily Cline
• Kelly Faye Coffin, RN
• Collinsville Family Pharmacy LC
• Collinsville Family Pharmacy LC
• Collinsville Primary Eyecare
• Collinsville Public Schools
• Collinsville Rural Fire Protection District

• Family Medicine Physician in Collinsville, OK
• Providers in Collinsville, 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 Mar 12, 2009; 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.