NPIMap

Organization Active NPI

Boulevard Family Clinic LLC

  • Family Medicine Physician
  • Edmond, OK
National Provider Identifier
1760774814
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOULEVARD FAMILY CLINIC LLC
Practice address
3431 S Boulevard
Suite 109
Edmond, OK 73013-5475
Phone
(405) 470-1884
NPI assigned
May 9, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Authorized official

Name
T Denise Cato
Title
Administrator
Phone
(405) 470-1884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3431 S Boulevard
Suite 109
Edmond, OK 73013-5475

Mailing address

3431 S Boulevard
Suite 109
Edmond, OK 73013-5475
Phone (405) 470-1884

National Provider Directory

National Provider Directory

Locations

3431 S Boulevard
Ste 109
Edmond, OK 73013
Phone (405) 470-1884

NPI Registry JSON

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

{
    "created_epoch": "1304899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304899200000",
    "number": "1760774814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3431 S BOULEVARD",
            "address_2": "SUITE 109",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135475",
            "telephone_number": "405-470-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 S BOULEVARD",
            "address_2": "SUITE 109",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730135475",
            "telephone_number": "405-470-1884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD FAMILY CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-09",
        "last_updated": "2011-05-09",
        "status": "A",
        "authorized_official_last_name": "CATO",
        "authorized_official_first_name": "T",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "405-470-1884"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; 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.