Next Generation Family Medical Clinic, LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

4383 Issued in OK

Legal business name

NEXT GENERATION FAMILY MEDICAL CLINIC, LLC

Practice address

1102 W Cherokee St Ste a
Wagoner, OK 74467-4600

Phone

(918) 201-4502

Fax

(918) 201-4503

NPI assigned

Aug 6, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Michele Bucholtz, D.O.,PH.D

Title

President

Phone

(918) 201-4502

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1438819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456099200000",
    "number": "1548646052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1102 W CHEROKEE ST STE A",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674600",
            "telephone_number": "918-201-4502",
            "fax_number": "918-201-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1102 W CHEROKEE ST STE A",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744674600",
            "telephone_number": "918-201-4502",
            "fax_number": "918-201-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEXT GENERATION FAMILY MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-06",
        "last_updated": "2016-02-22",
        "status": "A",
        "authorized_official_last_name": "BUCHOLTZ",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "918-201-4502",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O.,PH.D"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "OK",
            "license": "4383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275754780",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Wagoner, OK
• Providers in Wagoner, OK by specialty
• General Practice Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2016; 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.