Active NPI
CMG Family Clinic LLC
- Family Medicine Physician
- Tahlequah, OK
National Provider Identifier
1659568301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R0067005
- Legal business name
- CMG FAMILY CLINIC LLC
- Practice address
- 1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4133 - Phone
- (918) 453-1234
- Fax
- (918) 453-9107
- NPI assigned
- Sep 26, 2007
- Organization subpart
- Yes
- Parent organization
- CMG FAMILY CLINIC LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa A Swarer
- Title
- Manager
- Phone
- (918) 453-1234
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R0067005 | OK | Primary |
Addresses
Primary practice location
1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4133
Mailing address
1203 E Ross Byp
Suite a
Tahlequah, OK 74464-4133
Phone (918) 453-1234
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 600522432 | Other | OK | MEDICARE GROUP NUMBER |
Other names 1
- Enlow Family Practice
National Provider Directory
National Provider Directory- Part of
- CMG Family Clinic
Ownership & related parties
Parent organization (reported in NPPES) 1
This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.
-
- Family Medicine Physician
- Wagoner, OK
- NPI 1386817872
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190764800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1209427200000",
"number": "1659568301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1203 E ROSS BYP",
"address_2": "SUITE A",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744644133",
"telephone_number": "918-453-1234",
"fax_number": "918-453-9107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1203 E ROSS BYP",
"address_2": "SUITE A",
"city": "TAHLEQUAH",
"state": "OK",
"postal_code": "744644133",
"telephone_number": "918-453-1234",
"fax_number": "918-453-9107"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CMG FAMILY CLINIC LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "CMG FAMILY CLINIC LLC",
"enumeration_date": "2007-09-26",
"last_updated": "2008-04-29",
"status": "A",
"authorized_official_last_name": "SWARER",
"authorized_official_first_name": "LISA",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "918-453-1234"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "OK",
"license": "R0067005",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE GROUP NUMBER",
"identifier": "600522432",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Enlow Family Practice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Tahlequah, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.