CMG Family Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

21712 Issued in OK

Legal business name

CMG FAMILY CLINIC

Practice address

1317 S Dewey Ave
Wagoner, OK 74467-7013

Phone

(918) 485-9696

Fax

(918) 485-1701

NPI assigned

Apr 7, 2008

Organization subpart

No

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

Authorized official

Name

Lisa A Swarer

Title

Operations Manager

Phone

(918) 453-1234

Specialties & licenses 1

Addresses

Other identifiers 2

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• CMG Family Clinic LLC

  • Family Medicine Physician
  • Tahlequah, OK
  • NPI 1659568301
  NPPES parent name

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

{
    "created_epoch": "1207526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210723200000",
    "number": "1386817872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1317 S DEWEY AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744677013",
            "telephone_number": "918-485-9696",
            "fax_number": "918-485-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S DEWEY AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744677013",
            "telephone_number": "918-485-9696",
            "fax_number": "918-485-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CMG FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-07",
        "last_updated": "2008-05-14",
        "status": "A",
        "authorized_official_last_name": "SWARER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "918-453-1234"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "21712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "600522432",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "OK100338",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Gayle Clark
• Michael D Clark, PT
• Sylvia Clark
• Jeremiah Thomas Cleveland
• Gayle Cline, OTR
• Norma C Cobb, C.A.D.C.
• Harry O Colbert III
• Myrtle L Collins
• Ethan Garret Colwell
• Sandra Cooper

• All providers in Wagoner, OK
• Family Medicine Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2008; 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.