Provider Demographics
NPI:1447661962
Name:WILDHORSE FAMILY PRACTICE & URGENT CARE INC
Entity type:Organization
Organization Name:WILDHORSE FAMILY PRACTICE & URGENT CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:918-647-7829
Mailing Address - Street 1:26256 CAUGHRON RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:OK
Mailing Address - Zip Code:74932-2376
Mailing Address - Country:US
Mailing Address - Phone:918-647-7829
Mailing Address - Fax:918-654-3020
Practice Address - Street 1:3807 W CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2452
Practice Address - Country:US
Practice Address - Phone:918-647-7829
Practice Address - Fax:918-654-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1141OtherCLINIC