Erick Derocher D O Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OK2573 Issued in OK

Legal business name

ERICK DEROCHER D O INC

Doing business as

Family Medical Clinic of Western Oklahoma

Practice address

411 N Randall Ave
Elk City, OK 73644-4127

Phone

(580) 243-2273

Fax

(580) 243-2832

NPI assigned

Sep 28, 2006

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Erick Charles Derocher, D.O.NPI 1750393260

Title

President

Phone

(580) 243-2273

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Family Medical Clinic of Western Oklahoma Doing business as

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Locations

Practitioners 2

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.

• Erick Charles Derocher, D.O.

  • Family Medicine Physician
  • Elk City, OK
  • NPI 1750393260
  Medicare reassignment Care Compare group NPD Authorized official
• Amanda Lynn Lafarlette, APRNC-NP

  • Nurse Practitioner
  • Elk City, OK
  • NPI 1255343638
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1316039688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 N RANDALL AVE",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736444127",
            "telephone_number": "580-243-2273",
            "fax_number": "580-243-2832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 N RANDALL AVE",
            "city": "ELK CITY",
            "state": "OK",
            "postal_code": "736444127",
            "telephone_number": "580-243-2273",
            "fax_number": "580-243-2832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERICK DEROCHER D O INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "DEROCHER",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "580-243-2273",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "OK2573",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200081510A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Clinic of Western Oklahoma",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Medicine Physician in Elk City, OK
• Providers in Elk City, 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 Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.